186 / 236
Bleier et al.
TABLE 1.
Preoperative characteristics
Presenting symptoms, n (%)
Visual impairment
15 (65.2)
Proptosis
8 (34.8)
Pain
6 (26.1)
Diplopia
5 (21.7)
On-head swelling
1 (4.3)
Location, n (%)
Intraconal
14 (60.9)
Optic canal
5 (21.7)
Extraconal
3 (13.0)
Mixed
1 (4.3)
Imaging, n (%)
CT
23 (100.0)
MRI
22 (95.7)
Angiography
1 (4.3)
Tumor size (cm), mean
±
SD
Anterior-posterior
1.57
±
0.70
Medial-lateral
1.15
±
0.65
Superior-inferior
1.09
±
0.48
CT
=
computed tomography; MRI
=
magnetic resonance imaging; ON
=
optic
nerve; SD
=
standard deviation.
FIGURE 1.
Endoscopic view of a right intraconal OCH demonstrating a
3-handed approach for exposure (white arrow represents the OCH). IR
=
inferior rectus muscle; MR
=
medial rectus muscle, OCH
=
orbital cavernous
hemangioma.
Intraconal lesions were more likely to be associated with
incomplete resection (31.25%) as compared to extraconal
lesions (14.29%). Intraconal lesions also carried a higher
risk of immediate postoperative diplopia and enophthalmos
and were more likely to lead to a decision to reconstruct
the orbit (Table 5). Among all patients with postoperative
diplopia, only one-half were associated with medial rectus
retraction (Table 6).
TABLE 2.
Approach vs tumor location
Location
n (%)
Intraconal (n
=
16)
Approach
Single nostril
10 (62.5)
Binarial
6 (37.5)
Number of hands/surgeons
2/1
5 (31.3)
3/2
5 (31.3)
4/2
6 (37.5)
Extraconal (n
=
7)
Approach
Single nostril
7 (100.0)
Binarial
0 (0.0)
Number of hands/surgeons
2/1
2 (28.6)
3/2
5 (71.4)
4/2
0 (0.0)
Discussion
Although endoscopic skull base and orbital surgery share
a common historical origin in time,
3,4
their proliferation
has diverged over the subsequent decades. The reasons
for this are likely multifactorial and may include the rela-
tive paucity of medial intraorbital pathology,
15
the lack of
widespread collaborative oculoplastic and rhinology teams,
as well as a general unfamiliarity among rhinologists with
respect to medial intraconal neurovascular anatomy
16
and
intraorbital dissection techniques. As endoscopic skull base
techniques have become more widely utilized and accepted,
however, approaches to the orbit have experienced a re-
birth, with an increasing number of papers being published
on the subject in recent years.
13,17
Consequently, this study
was conceived in an effort to examine the independent en-
doscopic techniques developed at multiple experienced in-
stitutions to deal with a single type of lesion.
The preoperative workup for OCH was found to be sim-
ilar among all groups. The vast majority of patients un-
derwent both CT and MRI whereas only 1 underwent an-
giography. In general, angiography is not necessary because
OCHs tend to have characteristic imaging findings that are
generally sufficient to make the diagnosis.
14
Furthermore,
the majority of procedures were undertaken using image
guidance, which may be helpful, particularly when utilizing
a limited orbitotomy to identify a small intraconal lesion
that is mobile and obscured by periorbital fat.
Intraoperatively, there was general consensus that le-
sions located in the extraconal space could be sufficiently
International Forum of Allergy & Rhinology, Vol. 6, No. 2, February 2016
164