title: Removal of an orbital apex hemangioma using an endoscopic transethmoidal approach: technical note.
abstract: OBJECTIVE
  The posterior orbit contains a number of important and vulnerable structures, including the optic nerve, the ophthalmic artery and vein, and the ocular muscles and their motor nerves, which makes surgical access to the lesion in this region quite difficult. Transfrontal, transfrontal-ethmoidal, and transmaxillary procedures have the disadvantage of possible injuries to a number of nontumor structures, whereas an endoscopic transethmoidal approach is a minimally invasive surgery for the retrobulbar lesions. Retrobulbar cavernous hemangioma was successfully removed by a transethmoidal approach.
  
  
  METHODS
  Tumor removal was performed in a patient with an intraconal cavernous hemangioma of approximately 15 mm in diameter. By a transethmoidal approach, the medial-inferior part of the orbit, as well as the apex of the orbit, were clearly visualized after endonasal ethmoidectomy. After the removal of the medial orbital bone, the orbital periosteum was incised and elevated. By elevating the orbital fat, the tumor could be identified separately from the orbital contents.
  
  
  RESULTS
  Cavernous hemangioma at the orbital apex was removed without complications.
  
  
  CONCLUSIONS
  An endoscopic transethmoidal approach, which requires no skin incision, is a minimally invasive surgery for retrobulbar orbital tumor, leading to excellent cosmetic results with less bleeding.
authors.affiliation: Department of Otolaryngology, Kagawa University Faculty of Medicine, Kagawa, Japan. ironman@med.kagawa-u.ac.jp
authors.forename: Masayuki
authors.initials: M
authors.lastname: Karaki
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Nozomu
authors.initials: N
authors.lastname: Mori
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005004:Ethmoid Bone / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000033:anatomy & histology / Q000601:surgery; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009900:Optic Nerve / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery; D009915:Orbit / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D009918:Orbital Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010256:Paranasal Sinuses / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D010521:Periosteum / Q000033:anatomy & histology / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome