The transmaxillary endoscopic approach to the inferior part of the orbit

The transmaxillary endoscopic approach to the inferior part

Acta Neurochir (2015) 157:625–628

Transmaxillary endoscopic approach to the inferior part of the orbit was demonstrated on cadaveric preparations; however, its clinical application has not been reported. We describe a clinically useful technique of the transmaxillary approach to the lower orbit.

Methods A four-hand technique is essential for extensive preparation within the orbit; therefore, the tools have to be introduced into the maxillary sinus through two ports: either through the canine fossa and antrostomy or through antrostomy using the bi-nostril transseptal approach.

Conclusion Intraorbital pathologies located in the inferior retrobulbar space can be successfully operated on using the transmaxillary endoscopic approach.

Endoscopic lateral orbitotomy

Endoscopic lateral orbitotomy

Acta Neurochir (2014) 156:1897–1900

Lateral orbitotomy can be minimalized using contemporary endoscopy.

Methods Anatomy of the temporal fossa/orbital wall junction is described. The attachment of the temporal fascia is cut off from the orbital rim through a 1.5 cm skin incision in the lateral orbital wrinkle. The temporal muscle is detached from the bone to create a space for the telescope. An appropriate bone opening in the lateral orbital wall is created with the aid of neuronavigation to handle intraorbital pathology.

Conclusion Endoscopic lateral orbitotomy is an original alternative to the microsurgical Krönlein approach and yields good functional and cosmetic results.

The Mirroring Technique: A Navigation-Based Method for Reconstructing a Symmetrical Orbit and Cranial Vault

Mirroring technique

Neurosurgery 73[ONS Suppl 1]:ons24–ons29, 2013

The reconstruction of orbital structures and the cranial vault curvature can be challenging after trauma or wide resections for tumors. Sophisticated methods have been developed recently, but these are resource- and time-consuming.

OBJECTIVE: We report the mirroring technique, which is an effective and costless application for navigation-guided reconstruction procedures.

METHODS: At the time of the reconstruction, high-resolution images are reloaded while forcing a left-right axial flip. The pointer subsequently enables a virtual 3- dimensional projection of the position of the contralateral normal anatomy.

RESULTS: This method was applied successfully in 2 cases of en plaque sphenoid wing meningiomas with secondary exophthalmia.

CONCLUSION: The mirroring technique represents an accurate method of outlining the contralateral normal anatomy onto the pathological side based on navigation guidance.


Categorization and characterization of lesions of the orbital apex

Neuroradiology (2011) 53:89–107. DOI 10.1007/s00234-010-0712-7

The apex of the orbit is formed by the union of the lesser and greater wings of the sphenoid bone and acts as an osseous tunnel for numerous neurovascular structures entering the orbit from the cranial vault. Lesions of the orbital apex are clinically important as they can have an adverse effect on vision. A broad range of lesions can occur here, and our purpose is to organize the pathologic processes which occur in the orbital apex into logical imaging differentials, establish an organized approach to image analysis, and present examples of representative lesions.

Methods We review the anatomy of the orbital apex and categorize and describe the pathologic entities that are encountered most frequently in this anatomically compact region and identify imaging patterns that can help to narrow the differential diagnosis.

Results Categories of orbital apex lesions include neoplasms, inflammatory processes, infections, lesions causing extrinsic compression, and vascular lesions. This categorization provides an organized framework to facilitate a reasonable differential diagnosis. Computed tomography and magnetic resonance imaging are the modalities of choice to evaluate and characterize orbital apex lesions, and imaging examples utilizing these modalities will be presented.

Conclusion The orbital apex is a clinically important anatomical region and hosts diverse pathologic processes. An awareness of common imaging patterns can help to generate a focused differential diagnosis. A systematic categorical approach can be of help to radiologists attempting to accurately characterize lesions in this area.