Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas
Date
2013
Authors
Wu, W.
Selva-Nayagam, D.
Jiang, F.
Jing, W.
Tu, Y.
Chen, B.
Shi, J.
Sun, M.
Qu, J.
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Journal article
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American Journal of Ophthalmology, 2013; 156(3):593-599
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Wencan Wu, Dinesh Selva, Fangzheng Jiang, Wentao Jing, Yunhai Tu, Ben Chen, Jieliang Shi, Michelle T. Sun, and Jia Qu
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Abstract
<h4>Purpose</h4>To determine the indications for the addition of a transcaruncular approach along with detachment of the medial rectus muscle during the removal of small apical cavernous hemangiomas using an endoscopic transethmoidal approach.<h4>Design</h4>Retrospective, noncomparative case series.<h4>Methods</h4>Multicenter study of 12 patients with apical orbital tumors removed using an endoscopic transethmoidal approach. The decision to detach the medial rectus muscle with the addition of a transcaruncular approach was made during surgery for tumors largely lateral to the medial rectus muscle. Tumors adjacent to the medial orbital wall were removed via an endoscopic transethmoidal approach alone.<h4>Results</h4>Seven tumors were removed via an endoscopic transethmoidal approach combined with medial rectus muscle detachment, whereas 5 patients underwent removal without detachment of the medial rectus. All patients had visual impairment. Complete excision of the hemangiomas was achieved in all patients and tumor size ranged from 6 × 5 mm to 20 × 12 mm. The mean postoperative follow-up time was 11.8 ± 4.3 months. At final follow-up, the best-corrected visual acuity improved in 11 patients. Three patients had transient horizontal diplopia resulting from partial paralysis of the medial rectus muscle after detachment during surgery.<h4>Conclusions</h4>The endoscopic transethmoidal approach with or without medial rectus detachment is a promising approach for selected small cavernous hemangiomas located at the deep medial orbital apex. Detachment of the medial rectus muscle can be a useful technique for tumors located largely lateral to the medial rectus muscle. Further studies will be required to demonstrate the safety and efficacy of this technique.
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© 2013 by Elsevier Inc. All rights reserved.