title: Transnasal approach to the orbital apex and cavernous sinus.
abstract: OBJECTIVE
  The aim of this study was to provide the anatomic rationale for a transnasal approach to the orbital apex and cavernous sinus, and to evaluate its applicability and efficiency.
  
  
  METHODS
  One hundred patients with lesions of the orbital apex, cavernous sinus, optic nerve, clivus, parapharyngeal space, infratemporal fossa, or pterygopalatine fossa were reviewed over a 10-year period. All patients underwent an endoscopic transnasal approach to the orbital apex and cavernous sinus. The surgical technique required a standard endoscopic sinus surgery set. The possible complications were recorded and classified as intraoperative or postoperative.
  
  
  RESULTS
  There were complications in 8 cases: 4 intraoperative and 4 postoperative. The intraoperative complications included rupture of the internal carotid artery in 1 patient and cerebrospinal fluid leak in 3 patients. All intraoperative complications were resolved during surgery. The postoperative complications were transitory eyelid ptosis in 2 patients (resolved in 6 months) and transitory diplopia with immediate deficit of the medial rectus muscle in 2 patients (completely resolved in 1 month).
  
  
  CONCLUSIONS
  With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her way, thereby significantly reducing the rate of complications.
authors.affiliation: Felippu Institute, São Paolo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Felippu
authors.forename: Renzo
authors.initials: R
authors.lastname: Mora
authors.forename: Luca
authors.initials: L
authors.lastname: Guastini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Peretti
mesh_terms: D001763:Blepharoptosis / Q000209:etiology; D002426:Cavernous Sinus / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D003388:Cranial Fossa, Posterior / Q000601:surgery; D004172:Diplopia / Q000209:etiology; D006801:Humans; D006987:Hypesthesia / Q000601:surgery; D007239:Infections / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D009900:Optic Nerve / Q000601:surgery; D009915:Orbit / Q000601:surgery*; D056739:Pterygopalatine Fossa / Q000601:surgery; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D012888:Skull Neoplasms / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000601:surgery; D014786:Vision Disorders / Q000601:surgery