Endoscopic transnasal management of intraorbital lesions: our personal experience

Introduction: Among transnasal corridors, the transorbital one represents a valuable solution to manage the medial portion of the orbital spaces. We present our experience on intraorbital lesions managed by means of an endonasal endoscopic approach, discussing possible advantages and some technical nuances that can be useful for addressing these complex lesions. Material&Methods: We collected data on 6 intraorbital medially-located lesions, all managed by means of an endonasal route. Clinical features, histology, size of the lesion, type of surgery and complication rate were evaluated. All patients were studied with a CT scan and MRI and the relationship of the lesion was accurately evaluated, especially regarding the optic nerve. Results: Endoscopic endonasal approach was effective in removing completely intraorbital extra-intraconal tumors in 3 cases, in performing biopsies for histological diagnosis in 2 intraorbital intraconal lesions, and in draining one extraconal abscess. No major complications were noted. In no case there was evidence of optic nerve injury. Minor temporary complications (diplopia) were seen only in 1 case. Enophthalmus was observed in one case. Conclusion: Transorbital endoscopic endonasal approach should be considered a valid alternative in case of medially located lesions, both extra and intraconal.Our preliminary clinical experience suggests that this kind of lesions, and in particular the infero-medial ones, can be successfully and safely managed by such an approach. The well-known advantages of the endoscopic techniques, namely the lack of external scars, less bleeding, shorter hospital stay, and fewer complications, are confirmed.