Purpose

To demonstrate a combined Orbit-ENT endoscopic endonasal approach for resection of an apex medial intraconal orbital tumor with compressive optic neuropathy, as a minimally invasive alternative to open orbitotomy.

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Methods

A 30-year-old male presented with worsening left-eye vision and 5mm proptosis OS. He had early signs of optic neuropathy with a documented enlarged blind spot on Goldmann visual field. MRI revealed a 29×23×26mm cavernous hemangioma at the left orbital apex with significant optic nerve displacement (CHEER IVa / ORBIT III). Computer-assisted Orbit-ENT endoscopic endonasal surgery was performed with stereotactic navigation. Left-sided anterior and posterior ethmoidectomy, sphenoidotomy, middle meatal antrostomy, and Draf IIa frontal sinusotomy established the surgical corridor. A posterior septectomy created a septal window enabling binasal four-handed instrumentation. Medial orbital wall decompression exposed the periorbita, which was incised between the medial and inferior rectus muscles. Bimanual intraconal dissection was performed with the medial rectus reflected superiorly. The tumor was mobilized and removed en bloc using a cusp grasper and Rhoton dissector. Nasal mucosal graft and custom silastic stents were used to reconstruct the medial orbital wall and promote nasal healing.

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Results

The patient was discharged the same day with no intraoperative or postoperative complications. At two weeks, RAPD and proptosis resolved with no enophthalmos. At 10 months, visual function fully recovered.

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Conclusion

Endoscopic endonasal surgery provides a minimally invasive approach to apical medial intraconal lesions, offering a compelling alternative to open orbitotomy for select cases. This collaborative Orbit-ENT approach affords excellent visualization, simultaneous optic nerve decompression, and favorable functional outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Weronika	Jakubowska	University of British Columbia
Borja	Bazen	University of British Columbia
Arif	Janjua	University of British Columbia

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