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Endoscopic transnasal image-guided approach to diagnosis in orbital apex and optic canal lesions

Published online by Cambridge University Press:  04 July 2019

S N Unadkat ,
C E Rennie  and
W E Grant
S N Unadkat*
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
C E Rennie
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
W E Grant
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Author for correspondence: Mr Samit N Unadkat, Department of Otolaryngology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK E-mail: s.unadkat@nhs.net Fax: +44 (0)20 3312 1847
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Abstract

Objective

Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken.

Methods

Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance.

Results

Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa–Hunt syndrome cases.

Conclusion

A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.

Keywords

Orbital PseudotumorCranial Fossa, AnteriorTolosa-Hunt SyndromeImage-Guided BiopsyCerebrospinal Fluid Leak

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 6 , June 2019 , pp. 501 - 507
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Mr S N Unadkat takes responsibility for the integrity of the content of the paper

Presented orally at the European Rhinologic Society, 22–26 April 2018, London, UK.

References

1Abuzayed, B, Tanriover, N, Gazioglu, N, Eraslan, BS, Akar, Z. Endoscopic endonasal approach to the orbital apex and medial orbital wall: anatomic study and clinical applications. J Craniofac Surg 2009;20:1594–600Google Scholar
2Yeh, S, Foroozan, R. Orbital apex syndrome. Curr Opin Ophthalmol 2004;15:490–8Google Scholar
3Sethi, DS, Lau, DP. Endoscopic management of orbital apex lesions. Am J Rhinol 1997;11:449–55Google Scholar
4Stokken, J, Gumber, D, Antisdel, J, Sindwani, R. Endoscopic surgery of the orbital apex: outcomes and emerging techniques. Laryngoscope 2016;126:20–4Google Scholar
5Sia, DI, Chan, WO, Wormald, PJ, Davis, G, Selva, D. Decompression of benign orbital apex lesion via medial endoscopic approach. Orbit 2012;31:344–6Google Scholar
6Vohra, ST, Escott, EJ, Stevens, D, Branstetter, BF. Categorization and characterization of lesions of the orbital apex. Neuroradiology 2011;53:89–107Google Scholar
7Hunt, WE. Tolosa-Hunt syndrome: one cause of painful ophthalmoplegia. J Neurosurg 1976;44:544–9Google Scholar
8Hunt, WE, Meagher, JN, Lefever, HE, Zeman, W. Painful ophthalmoplegia. Its relation to indolent inflammation of the cavernous sinus. Neurology 1961;11:56–62Google Scholar
9Murchison, AP, Rosen, MR, Evans, JJ, Bilyk, JR. Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope 2011;121:463–7Google Scholar
10The Intercollegiate Surgical Curriculum. In: https://www.iscp.ac.uk/static/public/syllabus/syllabus_oto_2017.pdf [20 November 2018]Google Scholar
11Szentirmai, O, Hong, Y, Mascarenhas, L, Salek, AA, Stieg, PE, Anand, VK et al. Endoscopic endonasal clip ligation of cerebral aneurysms: an anatomical feasibility study and future directions. J Neurosurg 2016;124:463–8Google Scholar
12Eisen, MD, Yousem, DM, Loevner, LA, Thaler, ER, Bilker, WB, Goldberg, AN. Preoperative imaging to predict orbital invasion by tumor. Head Neck 2000;22:456–62Google Scholar
13Ben Simon, GJ, Annunziata, CC, Fink, J, Villablanca, P, McCann, JD, Goldberg, RA. Rethinking orbital imaging: establishing guidelines for interpreting orbital imaging studies and evaluating their predictive value in patients with orbital tumors. Ophthalmology 2005;112:2196–207Google Scholar
14Hannerz, J. Recurrent Tolosa-Hunt syndrome. Cephalalgia 1992;12:45–51Google Scholar
15Smith, JR, Rosenbaum, JT. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol 2001;85:1220–4Google Scholar
16Mormont, E, Laloux, P, Vauthier, J, Ossemann, M. Radiotherapy in a case of Tolosa-Hunt syndrome. Cephalalgia 2000;20:931–3Google Scholar
17Ganiusmen, O, Citak, G, Samancioglu, A, Korkmaz, H, Binatli, AO. Anatomic evaluation of the ophthalmic artery in optic canal decompression: a cadaver study of 20 optic canals. Turk Neurosurg 2017;27:31–6Google Scholar