Visual outcomes after endoscopic endonasal resection of orbital lesions.

BACKGROUND: The endoscopic endonasal approach (EEA) has been gaining popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathologies. The purpose of this study was to examine the outcomes of patients who underwent EEA resection of orbital lesions at our center. METHODS: We performed a retrospective chart review on patients who underwent the EEA for resection of orbital lesions and orbital apex decompression January 1, 2006 and December 1, 2019. For all cases, patient demographics, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. RESULTS: Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including six male patients and three female patients. The mean age was 49.4 years with a mean follow-up of 3.8 (1 - 13.5) years. The orbital pathologies treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumour, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis All patients presented with exophthalmos of the affected orbit. Five patients presented with decreased visual acuity on exam. Postoperatively, one of these five patients improved to baseline visual acuity, three had stable vision, and one had brief improvement before suffering progressive visual decline one month after surgical intervention. Two patients presented with diplopia; both improved postoperatively. Three patients sustained new, transient and self-limiting postoperative diplopia. CONCLUSIONS: In patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients.