The Endoscopic Endonasal Approach for Orbital and Orbital Apex Lesions: A Series of 77 Patients

Objective: Traditional approaches to the orbit include “open” transorbital approaches. The endonasal endoscopic approach (EEA) has been employed for skull base lesions. A logical extension of this approach includes lesions of the orbit and orbital apex.

Methods: A retrospective review was conducted of all patients who underwent EEA for access to orbital pathology from 2002 to 2014.

Results: 77 patients underwent 81 endoscopic endonasal procedures for resection or decompression of symptomatic orbital pathology. The average age was 44.5 years. The most common presenting symptom was vision change (66.7%). The average follow-up was 23.5 months. Twenty-seven patients (33.3%) had extraorbital lesions with optic nerve compression. Fifty-four (66.7%) patients had intraorbital lesions, 26 (32.1%) of which were intraconal. Overall, 30 (37.1%) patients had an improvement based on subjective and clinical. Of the 27 patients with extraorbital lesions, 7 (25.9%) had improved vision postoperatively. Twenty (74.1%) had stable vision. For the 28 patients who intraorbital, extraconal lesions, 13 (46.4%) had improved symptoms postoperatively (improved vision or decreased proptosis). Fourteen (50.0%) patients had stable vision postoperatively. One patient (3.6%) suffered from a new cranial nerve IV palsy that improved by the first postoperative visit. Of the 26 intraconal lesions, 10 (38.4%) had improved symptoms. Fourteen (53.8%) had stable post-operative vision. Two (7.7%) patients suffered from postoperative orbital hematomas with worsening vision immediately after surgery.

Conclusion: The endoscopic endonasal approach is a safe and effective option for the treatment of select orbital and orbital apex lesions.