2016 Section 5 Green Book

OR I G I NAL ART I CLE

Endoscopic endonasal orbital cavernous hemangioma resection: global

experience in techniques and outcomes

Benjamin S. Bleier, MD

, Paolo Castelnuovo, MD

, Paolo Battaglia, MD

, Mario Turri-Zanoni, MD

Iacopo Dallan, MD

, Ralph Metson, MD

, Ahmad R. Sedaghat, MD, PhD

, S. Tonya Stefko, MD

Paul A. Gardner, MD

, Carl H. Snyderman, MD, MBA

, Joao Flavio Nogueira, MD

Vijay R. Ramakrishnan, MD

, Luca Muscatello, MD

, Riccardo Lenzi, MD

and Suzanne Freitag, MD

Background:

Endoscopic orbital surgery represents the

next frontier in endonasal surgery. The current literature is

largely composed of small, heterogeneous, case series with

li le consensus regarding optimal techniques. The purpose

of this study was to combine the experience of multiple in-

ternational centers to create a composite of the global ex-

perience on the endoscopic management of a single type

of tumor, the orbital cavernous hemangioma (OCH).

Methods:

This was a retrospective study of techniques for

endoscopic OCH resection from 6 centers on 3 continents.

Only primary data from strictly endoscopic resection of

OCHs were included. Responses were analyzed to quali-

tatively identify points of both consensus and variability

among the different groups.

Results:

Data for a total of 23 patients, 10 (43.5%) male

and 13 (56.5%) female were collected. The majority of le-

sions were intraconal (60.9%). The mean

standard de-

viation (SD) surgical time was 150.7

75.0 minutes with

a mean blood loss of 82.7

49.6 mL. Binarial approaches

(26.1%) were used exclusively in the se ing of intraconal le-

sions, which were associated with a higher rate of incom-

plete resection (31.3%), postoperative diplopia (25.0%),

and the need for reconstruction (37.5%) than extraconal le-

sions. Orthotropia and symmetric orbital appearance were

achieved in 60.9% and 78.3% of cases, respectively.

Conclusion:

Extraconal lesions were managed similarly;

however, greater variability was evident for intraconal le-

sions. These included the laterality and number of hands

in the approach, methods of medial rectus retraction, and

the need for reconstruction. The increased technical com-

plexity and disparity of techniques in addressing intraconal

OCHs suggests that continued research into the optimal

management of this subclass of lesions is of significant pri-

ority.

2015 ARS-AAOA, LLC.

Key Words:

endoscopic; orbital; intraconal; orbital cavernous heman-

gioma; outcomes

How to Cite this Article:

Bleier BS, Castelnuovo P, Ba aglia P, et al. Endoscopic en-

donasal orbital cavernous hemangioma resection: global

experience in techniques and outcomes.

Int ForumAllergy

Rhinol

. 2016;6:156–161.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary,

Harvard Medical School, Boston, MA;

Department of Biotechnology

and Life Sciences, Division of Otorhinolaryngology, University of

Insubria, Varese, Italy;

Department of Ophthalmology, University of

Pittsburgh Medical Center, Pittsburgh, PA;

Department of

Neurological Surgery, University of Pittsburgh Medical Center,

Pittsburgh, PA;

Division of Otolaryngology, Hospital Geral de

Fortaleza, Forta Leza, Brazil;

Division of Otolaryngology, University of

Colorado, Denver, CO;

Division of Otorhinolaryngology, General

Hospital of Massa, Massa, Italy

Correspondence to: Benjamin S. Bleier, MD, 243 Charles Street, Boston MA,

02114; e-mail:

benjamin_bleier@meei.harvard.edu

Potential conflict of interest: None provided.

To be presented at the ARS Annual Meeting, on September 27, 2015, in

Dallas, TX

ndoscopic orbital surgery represents the next frontier

in endonasal surgery. The feasibility of endoscopic

management of periorbital pathology including orbital

and optic nerve decompression

were first reported over

25 years ago. Over the next decade the first descriptions

of endonasal approaches within the intraconal space be-

gan to appear in the literature.

3,4

In subsequent years

however, only a limited number of case series from high-

volume institutions have been published, which report on

a variety of orbital pathologies.

5–10

During the same pe-

riod, the widespread proliferation of endoscopic skull-base

surgery has been mirrored by a body of literature that has

Received: 7 July 2015; Revised: 28 July 2015; Accepted: 11 August 2015

DOI: 10.1002/alr.21645

View this article online at

wileyonlinelibrary.com.

International Forum of Allergy & Rhinology, Vol. 6, No. 2, February 2016

Reprinted by permission of Int Forum Allergy Rhinol. 2016; 6(2):156-161.

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