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  • Minimally Invasive Surgery for Intraconal Orbital Tumors

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, January 2021

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    Caballero-García et al. set out to assess the efficacy of 360-degree minimally invasive endoscopic surgery for orbital intraconal tumors. They observed immediate and long-term favorable morphologic and aesthetic results.

    For this retrospective case series, the researchers included 22 adults (mean age, 52.3 ± 11 years). The pa­tients received endonasal surgery or an­terior orbitotomy with full endoscopic visualization during a five-year period at a clinic in Cuba. For each patient, the authors identified and classified the relationship between the tumor and the optic nerve: Type I lesions were upper medial to the optic nerve; type II lesions were lower medial; type III lesions were lower lateral; type IV lesions were upper lateral; and type V lesions were central­ly located and originated in the optic nerve itself or its sheet.

    An endonasal surgical approach was used for type I and II lesions. Type III and IV lesions had endoscopic anterior orbitotomy. For type V lesions, the surgical approach depended on the amount of space between the rectus muscles.

    Proptosis was present in 19 of the 22 patients, and visual loss was present in three patients. Cavernous hemangi­oma was the most common diagnosis (72.7%), followed by orbital sheet me­ningioma (9.1%). The most frequent tumor locations were types II and IV. Total resection was achieved in all but one patient. All patients with visual loss regained normal visual function after surgery, and orbital proptosis resolved in all 19 patients.

    Cavernous hemangiomas are ideal lesions for minimally invasive tech­niques because of their low flow, encap­sulated nature, and ease of extracap­sular dissection. However, the authors cautioned about the disadvantages of endoscopy, including the long learning curve and challenges in patient selec­tion. Although the minimally invasive procedure can be safe and effective in some patients with orbital intraconal tumors, larger studies are needed.

    The original article can be found here.