title: [Transnasal endoscopic removal of orbital apex cavernous hemangioma].
abstract: OBJECTIVE
  To explore the strategy and indications of endoscopic transnasal resection of orbital apex cavernous hemangiomas (OACH).
  
  
  METHODS
  Eleven patients aged from 30 to 62 years-old diagnosed as OACH bypostoperative histopathology were reviewed retrospectively. Four males and 7 females were included. Both ophthalmological examination and rhinologic evaluation were adopted preoperatively. The surgeries were carried out under general anesthesia endoscopically by the same senior surgeon. After ethmoidectomy, the orbital lamina papyracea was opened, and the orbital fat and muscles were pushed back into the orbit by using the brain cotton, and then the orbital tumor was removed. The patients were kept follow-up both in ophthalmologic and rhinologic departments.
  
  
  RESULTS
  As suggested by preoperative imagings, 4 lesions located in the extraconal space (nasal side), 6 between the optic nerve and the internal rectus muscle of the intraconal space, and 1 outside the optic nerve in the intraconal space. Total resection was achieved in 9 cases, and orbital decompressions were done in 2 cases. Meanwhile, orbital wall reconstruction was done in 7 cases. The follow up ranged from 6 to 47 months. Seven patients achieved visual acuity improvement and no deteriorations were found in other 4 patients. Defects of vision field in 3 patients disappeared after 2 weeks. No operative or postoperative complications occurred.
  
  
  CONCLUSIONS
  The OACH located in the nasal side of extraconal space and between the optic nerve and the internal rectus muscle of the intraconal space can be accessed endoscopically by intranasal approach. Using the brain cotton to push the orbital fat and muscles back into the orbit and an experienced endoscopic surgeon are important to access a successful intranasal endoscopic removal of orbital apex tumor.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education (Capital Medical University), Beijing 100730, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.forename: Qian
authors.initials: Q
authors.lastname: Huang
authors.forename: Bing
authors.initials: B
authors.lastname: Zhou
authors.forename: Ji-tong
authors.initials: JT
authors.lastname: Shi
authors.forename: Cheng-shuo
authors.initials: CS
authors.lastname: Wang
authors.forename: Sheng-zhong
authors.initials: SZ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D019299:Decompression, Surgical; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D009918:Orbital Neoplasms / Q000601:surgery*; D012189:Retrospective Studies