Endoscopic Approach to the Orbital Apex and Periorbital Skull Base

Objectives/hypothesis: To review cases of endoscopic orbital apex and periorbital skull base surgery and stratify the pathology and lesion location. Variations in surgical technique and the outcomes are reviewed. We report the results of all cases of endoscopic orbital apex surgery over a 40-month period. Eighteen cases with a variety of pathology, location in the orbital apex, and surgical technique are reviewed.

Study Design: Retrospective chart review.

Methods: All cases of endoscopic orbital apex and periorbital skull base surgery over a 40-month period were reviewed. Lesion location, surgical approach, pathology, and postoperative complications are summarized. The details of the technique as well as limitations and advantages of this approach are summarized.

Results: Eighteen patients who underwent endoscopic orbital apex surgery were identified. Eleven (61%) of the patients were men, and the average age was 51 years. The majority of lesions, 12 (67%), were located in the medial orbit and/or optic canal, two (11%) in the cavernous sinus and/or superior orbital fissure, and four (22%) in the inferior orbit and/or pterygopalatine fossa. The etiologies were diverse, including benign (44%), malignant (28%), infectious (11%), and inflammatory (17%). The majority of cases, 67%, were approached by the transnasal endoscopic technique followed by 28% with a combined transnasal and transcaruncular approach, and 6% by the sublabial approach. Complications occurred in 22% of cases.

Conclusions: Conventional orbitotomy techniques and craniotomy are frequently used to access lesions in the orbital apex. The more recently described endoscopic technique with intraoperative image guidance can provide access to a subset orbital apical and periorbital skull base lesions. In carefully selected cases, this technique provides excellent visualization and access to the orbital apex and avoids larger craniofacial surgeries.