Endoscopic Approaches to the Orbit: Transnasal and Transorbital: A Case Series

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Introduction: Traditionally, orbital pathologies requiring surgery have been treated through open approaches, with different techniques tailored to the lesion’s location. Recently, minimally invasive endoscopic techniques, such as the endoscopic endonasal approach (EEA) and the endoscopic transorbital approach (ETA), have been introduced into orbital surgery. This study aims to present the combined experience of the neurosurgical and ear-nose-throat (ENT) Units in utilizing these endoscopic approaches for orbital pathologies. Materials and Methods: We conducted a retrospective review of data from patients who underwent endoscopic orbital surgery at our institution between 2016 and 2021. Complications were evaluated using the Clavien-Dindo classification, and cosmetic outcomes were assessed with the Scar Cosmesis Assessment and Rating (SCAR) Scale. Results: During the study period, 39 patients met the inclusion criteria. Depending on the orbital quadrant involved, lesions were approached either with EEA (15 patients) or ETA (20 patients). In three cases, a combination of endoscopic techniques and anterior orbitotomy was used, while one patient underwent a combined EEA and ETA approach. Procedures performed included orbital biopsy (9 cases), orbital decompression (6 cases), subtotal lesion resection (STR) (8 cases), and total lesion resection (GTR) (16 cases). Postoperative complications included diplopia (5.1%, with one case of permanent diplopia), trigeminal paresthesia and dysesthesia (5.1%), palpebral edema (17.9%), and periorbital ecchymosis (7.7%). The average follow-up period was 21 months (range: 2–63 months). Conclusion: Endoscopic approaches to the orbital compartments offer minimally invasive access to all areas of the orbit, with a low complication rate and favorable cosmetic outcomes. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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