Endoscopic endonasal technique: treatment of paranasal - SciELO
Endonasal endoscopic approach for orbital...
Transcript of Endonasal endoscopic approach for orbital...
Awadhesh Kumar Jaiswal
Professor, Department of Neurosurgery,
Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow, INDIA-226014
Endonasal endoscopic approach
for orbital lesions
• Orbital tumors: not very common
• Treatment: Surgical excision
• Approaches:
Endonasal endoscopic
Lateral
orbitotomy
Trans-cranial
Trans-
conjunctival
Introduction
ORBIT ORBIT
NASAL CAVITY
ETHMOID
ETHMOID
Endonasal endoscopic approach
• Minimally invasive
• Direct access
NASAL CAVITY
ORBIT
Endonasal endoscopic approach4 gates
• Uncinate process
• Bulla ethmoidale
• Ground lamella
• Ant. Sphenoid wall
Nasal cavity
• 35/M
• Rt. proptosis
• Diplopia
O/E:
• Rt axial proptosis
• Vn – R 6/9, L 6/6
• EOM– Rt restricted
• No other deficit
4 mon.
• 74/F
• Lt. proptosis - 9 mon.
O/E:
• Lt axial proptosis
• Lt APD
• EOM– Lt restricted
• No other deficit
• 39/F
• Rt. proptosis - 6 months
O/E:
• Rt axial proptosis
• Vn – B/L 6/6
• EOM– Rt restricted
• No other deficit
• 61/M
• Trauma Lt eye-3 yr
• Lt. proptosis-10 mon.
O/E:
• Lt proptosis
• Vn – Lt PL -ve
• EOM– Lt ophthalmoplegia
• No other deficit
N= 20
Extent of excision
• Total -19; Subtotal-1
Complications-
• Mild lid edema-6
• Transient ophthalmoparesis-7
• Visual deterioration-3
• Anophthalmos - 1
Our experience
• Cavernous angioma - 5
• Schwannoma - 5
• Pilocytic astrocytoma – 3
• Epidermoid - 1
• Solitary fibrous tumor – 1
• Poorly diff. metastatic CA - 1
• Lymphoid hyperplasia- 1
• Meningioma - 1
• Mesenchymal tumor- 1
• Neurocysticercosis- 1
Histopathology (n=20)
• 2 Dimensional image
• Steep learning curve
• Limited working space
• Not all tumors can be dealt with
Limitations:
Endonasal endoscopic approach for orbit
• Direct access and minimally invasive
• Well suited for lesions located in the
medial part of orbit and orbital apex.
• Scarless
• Less tissue trauma
• Less operative time
• Excellent result with minimal complications
Conclusions