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    AAO 2019 Video Program
    Oculoplastics/Orbit

    In this video we demonstrate the combined use of next-generation technology in excision of medial/inferiomedially based cavernous hemangioma at the orbital apex with severe compressive optic neuropathy. After endoscopic ethmoidectomy, limited lamina papyraceous and periosteum removal was done under endoscopic navigation guidance. For extraconal cavernoma, dissection was carried out until the tumor base was released from the annulus of Zinn and any feeding vessel was cauterized. For intraconal cavernoma, a mastoid retractor was inserted to create a surgical corridor between the medial and inferior recti, which were retracted but not disinserted, after which dissection was carried out in the same manner. This endoscopic extraorbital approach allowed pressure-less removal of apical lesion and minimized iatrogenic compression on the already compromised optic nerve. The limited medial wall defect was reconstructed at the same or second stage using a 3D-printed template for molding of any type of sheet implant.