Endoscopic Power-Assisted Orbital Exenteration

Introduction: Orbital exenteration can be accomplished by an external eyelid-sparing or by an eyelid-sacrificing approach. The purpose of this report is to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods.

Methods: The study design is a retrospective analysis at a tertiary care referral center. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (1 case) are reported. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were utilized for resection in all cases.

Results: The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30 to 45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity "mucosalization" within 8 weeks. Two patients are alive without disease at 15 months' follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy.

Conclusion: This preliminary experience demonstrated endoscopic power-assisted orbital exenteration (EPOE) to be an effective technique for exenteration of the orbit. EPOE offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen, and (2) the ability to preserve the uninvolved superior and lateral periorbita. Intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.