title: Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes.
abstract: BACKGROUND
  Endoscopic orbital surgery represents the next frontier in endonasal surgery. The current literature is largely composed of small, heterogeneous, case series with little consensus regarding optimal techniques. The purpose of this study was to combine the experience of multiple international centers to create a composite of the global experience on the endoscopic management of a single type of tumor, the orbital cavernous hemangioma (OCH).
  
  
  METHODS
  This was a retrospective study of techniques for endoscopic OCH resection from 6 centers on 3 continents. Only primary data from strictly endoscopic resection of OCHs were included. Responses were analyzed to qualitatively identify points of both consensus and variability among the different groups.
  
  
  RESULTS
  Data for a total of 23 patients, 10 (43.5%) male and 13 (56.5%) female were collected. The majority of lesions were intraconal (60.9%). The mean ± standard deviation (SD) surgical time was 150.7 ± 75.0 minutes with a mean blood loss of 82.7 ± 49.6 mL. Binarial approaches (26.1%) were used exclusively in the setting of intraconal lesions, which were associated with a higher rate of incomplete resection (31.3%), postoperative diplopia (25.0%), and the need for reconstruction (37.5%) than extraconal lesions. Orthotropia and symmetric orbital appearance were achieved in 60.9% and 78.3% of cases, respectively.
  
  
  CONCLUSIONS
  Extraconal lesions were managed similarly; however, greater variability was evident for intraconal lesions. These included the laterality and number of hands in the approach, methods of medial rectus retraction, and the need for reconstruction. The increased technical complexity and disparity of techniques in addressing intraconal OCHs suggests that continued research into the optimal management of this subclass of lesions is of significant priority.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
authors.affiliation: Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
authors.affiliation: Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Battaglia
authors.affiliation: Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.affiliation: Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.affiliation: Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: S Tonya
authors.initials: ST
authors.lastname: Stefko
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.affiliation: Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.affiliation: Division of Otolaryngology, Hospital Geral de Fortaleza, Forta Leza, Brazil.
authors.forename: Joao Flavio
authors.initials: JF
authors.lastname: Nogueira
authors.affiliation: Division of Otolaryngology, University of Colorado, Denver, CO.
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
authors.affiliation: Division of Otorhinolaryngology, General Hospital of Massa, Massa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Muscatello
authors.affiliation: Division of Otorhinolaryngology, General Hospital of Massa, Massa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lenzi
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Freitag
mesh_terms: D000328:Adult; D004172:Diplopia / Q000209:etiology; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D017949:Retinal Cone Photoreceptor Cells / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: endoscopic; intraconal; orbital; orbital cavernous hemangioma; outcomes