Endoscopic Surgery of the Orbit

Cover
Inside Front cover
Endoscopic Surgery of the Orbit
Copyright
Dedication
Preface
Biography
Video Contents
Contributors
Part 1: Perspectives and Evolution in Techniques
Endoscopic Orbital Surgery: The Rhinologists Perspective
	Endoscopic Dacryocystorhinostomy
		Key Concepts and Lessons Learned
	Endoscopic Orbital Decompression
		Key Concepts and Lessons Learned
	Endoscopic Optic Nerve Decompression
	Endoscopic Resection of Orbital Tumors
	Future Directions
	Conclusion
	References
Endoscopic Orbital Surgery: The Ophthalmologists Perspective: Formation of the Ophthalmology-Otolaryngology Team
	References
Endoscopic Orbital Surgery: The Neurosurgeons Perspective
	Transorbital Approaches
		Superior Eyelid Crease Approach
		Lateral Retrocanthal Approach
		Precaruncular Approach
		Preseptal Lower Eyelid Approach
	Conclusion
	References
Part 2: Evaluation, Anatomy, and Imaging
Surgical Anatomy of the Orbit, Including the Intraconal Space
	Anatomy of the Orbit
		Orbital Cavity
		Orbital Fascia or Periorbita
		Orbital Contents
		Orbital Muscles
		Intraconal Space
		Arteries of the Orbit
		Veins of the Orbit
		Nerves of the Orbit
		Lacrimal System
	References
Surgical Anatomy of the Nose, Septum, and Sinuses
	Surgical Anatomy and Principles Relevant to the Orbital Surgeon
		Nares
		Nasal Septum
		Inferior Turbinate
		Middle Turbinate
		Maxillary Sinus
		Ethmoid Sinus
		Sphenoid Sinus
		Frontal Sinus
	Evaluation
		Nasal Endoscopy
	Imaging
		Computed Tomography
		Magnetic Resonance Imaging
	Conclusion
	References
Rhinologic Evaluation in Orbital and Lacrimal Disease
	Sinonasal Examination
	Lacrimal Disease
		Anatomy
		Rhinologic Evaluation
	Orbital Disease
	Summary
	References
Ophthalmologic Evaluation in Orbital and Lacrimal Disease
	History
	Medical History, Medications, and Allergies
	Ophthalmic Examination
		Visual Sensory System
		Oculomotor System
		Globe Evaluation
		Periocular Examination
		Lacrimal Examination
	Other Tests
	Summary
	References
Neuro-Ophthalmologic Evaluation and Testing
	Techniques for Assessing Visual Function
		Visual Field Testing and Automated Perimetry
		Proptosis
		Ocular Motility and Prism
		Ocular Coherence Tomography
Radiologic Evaluation of the Orbit: Computed Tomography and Magnetic Resonance Imaging
	Anatomy
		Osseous Anatomy
		Soft-Tissue Anatomy
	Imaging Considerations
	Computed Tomography
	Magnetic Resonance Imaging
	Protocols
		Computed Tomography of the Orbits
		Magnetic Resonance Imaging of the Orbits
	Conclusion
	References
Optimizing Visualization and Localization During Endoscopic Orbital Surgery
	Surgical Technique
	Handling of Bleeding During Surgery to Improve Visualisation
	Adjuncts for Intraorbital Tumor Dissection
	Dealing With Extraconal Muscles
	References
Part 3: Nasolacrimal Duct Obstruction and Endoscopic-DCR
Evaluation and Management of Congenital Nasolacrimal Duct Obstruction
	Epidemiology and Risk Factors
		Epidemiology
		Risk Factors
	Pathophysiology
	Diagnosis
		Differential Diagnosis
		Testing
	Management
		Conservative Management
		Procedural Management
			Probing the Nasolacrimal Duct
			Balloon Dilation
			Silicone Intubation
		Complications
		Follow-up
	Conclusion
	References
Evaluation and Management of Acquired Nasolacrimal Duct Obstruction
	Etiology
		Primary Acquired Nasolacrimal Duct Obstruction
		Secondary Acquired Nasolacrimal Duct Obstruction
	Evaluation
	Diagnostic Tests
	Imaging
	Management
	References
Endoscopic Dacrocystorhinostomy
	Workup
		Imaging
			Computed Tomography
			Contrast Dacryocystography
			Dacryoscintigraphy
		Endoscopy Evaluation
		Dye Disappearance Test
		Jones Tests
	Indications
	Operative Setup
		Instrumentation
	Surgical Procedure
	Postoperative Care and Considerations
		Dressings and Stents
		Antibiotics and Rinses
		Follow-up
	Risks and Benefits
	Sacks Six Causes of Failure
	References
Endonasal Dacryocystorhinostomy With Mucosal Flaps
	Preoperative Assessment
	Imaging: Dacrocystogram and Lacrimal Scintillography
	Surgical Technique
	Results of Powered Dacryocystorhinostomy
		Revisions
		Complications
		Additional Surgery
	Key Points
	References
Revision Endoscopic Dacryocystorhinostomy and Conjunctivodacryocystorhinostomy
	Causes of Dacryocystorhinostomy Failure
		Inadequate Bony Osteotomy
		Mucosal Scarring
		Concomitant Nasal Pathology or Anatomic Variations
		Functional Failure
		Upper System/Canalicular Stenosis
	Indications for Revision Surgery
	Surgical Technique
		Revision Endoscopic DCR
		Conjunctivodacryocystorhinostomy
	Additional Considerations
		Lacrimal Stents
		Mitomycin C
	Postoperative Care
	Outcomes
	Complications
	Conclusion
	References
Endoscopic Management of Pediatric Nasolacrimal Obstruction
	Simple Congenital Nasolacrimal Duct Obstruction
	Complex Congenital Nasolacrimal Duct Obstruction
	Dacryocele/Dacryocystocele, and Dacryocystitis
	Technique of Nasal Endoscopic-Assisted Probing and Irrigation
		Nasolacrimal Duct Irrigation and Probing
		Stenting
		Ballooning
		Endoscopic Dacryocystorhinostomy
	Summary
	References
Outcomes of Endoscopic Dacryocystorhinostomy: Enhancing the Patency of the Rhinostomy
	Outcomes of Endoscopic Dacryocystorhinostomy
	Nasolacrimal Stent Type
	Nasolacrimal Stent Timing
	Topical Mitomycin C
	Anti-Inflammatory Medications
	Conclusion
	References
Part 4: Endoscopic Orbital and Optic Nerve Decompression
Thyroid Eye Disease
	Epidemiology
	Pathophysiology
	Modifiable Risk Factors
		Smoking
		Radioactive Iodine Therapy
		Thyroid Dysregulation
		Hyperlipidemia
		Obstructive Sleep Apnea
	Diagnosis and Clinical Workup
	Differential Diagnosis
	Classification and Disease Activity
	Management of Thyroid Eye Disease
		Mild Disease
		Moderate to Severe Active Disease
			Corticosteroids
			Nonsteroidal Immunomodulatory Agents
			Orbital Radiotherapy
			Thyroidectomy
		Inactive Thyroid Eye Disease
			Surgical Decompression of the Orbit
			Strabismus Surgery
			Eyelid Retraction Surgery
	Considerations in Thyroid Eye Disease Optic Neuropathy
	Conclusions
	References
Surgical Indications and Outcomes of Orbital Decompression Surgery
	Surgical Indications
		Graves Ophthalmopathy
			Urgent Indications
			Nonurgent Indications
		Additional Indications
	Surgical Contraindications
	Patient Selection
	Outcomes
		Clinical Outcomes
		Radiographic-Based Outcomes
		Quality-of-Life Outcomes
	Pearls
	References
Endoscopic Orbital Decompression
	Anatomy
	Technique
	Complications
	References
Endoscopic Optic Nerve Decompression: Intracanalicular Portion
	The Evolution of Optic Nerve Decompression
	Anatomy
		The Orbital Apex
		The Optic Nerve and Its Canal
		Surrounding Structures
	Pathology Involving the Optic Nerve: Indications and Contraindications for Decompression
	Preoperative Considerations
		Preoperative Planning
		Preparation and Patient Positioning
	Pearls and Potential Pitfalls
		Pearls
		Potential Pitfalls
	Surgical Technique
		Approach: Endoscopic Endonasal Transsphenoidal
		Extradural Exposure: Transplanum Transtuberculum (Extended Transsphenoid)
		Intradural Exposure: Opening of the Optic Nerve Sheath
		Closure and Skull Base Reconstruction
	Postoperative Complications, Considerations, and Management
	References
Complications in Endoscopic Orbital Surgery
	Immediate/Early Complications
		Vascular Injuries
		Neural Injuries
		Muscular Injuries and Cerebrospinal Fluid Leaks
	Late Complications
		Sinonasal Complications
		Orbital Complications
	Preventing Complications
		Preoperative Evaluation
		Intraoperative Care
	Conclusions
	References
Postoperative Care of the Endoscopic Orbital Decompression Patient
	Perioperative
		Preoperative
		Intraoperative
		Postoperative
		Discharge
	Follow-up
	Conclusion
	References
Part 5: Endoscopic Intraorbital Surgery and Tumor Resection
Endoscopic Endonasal Approaches to the Orbit and Skull Base in the Coronal Plane
	Anatomy
	Indications
	Technique
	Case Example
	Complications
	Conclusions
	References
Intraorbital Pathology (Tumors) and Management Strategies
	Lymphoproliferative Tumors
		Burkitt Lymphoma
		Plasma Cell Tumors
	Histiocytic Tumors
		Juvenile Xanthogranuloma
		Adult Xanthogranuloma
		Langerhan Cell Histiocytosis
	Lacrimal Gland Tumors
		Dacryops
		Pleomorphic Adenoma
		Malignant Mixed Tumor
		Adenoid Cystic Carcinoma
	Neurogenic Tumors
		Meningioma
			Sphenoid Wing Meningioma
			Optic Nerve Sheath Meningioma
		Optic Nerve Glioma
		Neurofibroma
		Schwannoma
	Vascular Tumors and Malformations
		Capillary Hemangioma
		Cavernous Venous Malformation (Cavernous Hemangioma)
		Lymphatic Malformation (Lymphangioma)
		Arteriovenous Anomalies
			Arteriovenous Malformation
			Arteriovenous Fistula
		Venous Malformation (Orbital Varix)
	Fibrous Connective Tissue Tumors
	Myogenic Tumors
		Rhabdoyosarcoma
		Leiomyoma and Leiomyosarcoma
	Orbital Cystic Lesions
		Dermoid Cysts
		Mengingocele, Encephalocele, and Meningoencephalocele
		Mucocele
	Lipomatous Tumors
		Dermolipomas
	Metastatic Tumors
	References
Orbital Apex Surgery and Tumor Removal
	Preoperative Considerations
	Endoscopic Transnasal Approach to the Orbital Apex
		Intraconal Dissection
		Tumor Removal
		Reconstruction
	Transorbital Endoscopic-Assisted Approach
	Complications of Endoscopic Orbital Surgery
	References
Management of Intraconal Hemangioma: Techniques and Outcomes
	Epidemiology and Etiology
	Anatomic Location and Characteristics
	Clinical Presentation and Investigations
		Clinical Presentation
		Radiologic Investigations
	Management
		Indications and Surgical Approach
		Surgical Equipment and Techniques-Hands/Surgeons
		Surgical Management of the Medial Rectus
		Management of Hemostasis and Orbital Fat
		Resection Techniques for Intraconal Orbital Cavernous Hemangiomas
		Reconstruction of the Medial Orbital Wall
		The Role of Nasal Packing
	Endoscopic Orbital Cavernous Hemangioma Outcomes
	Conclusion
	References
Fibro-Osseous Lesions of the Orbit and Optic Canal
	Benign Fibro-Osseous Lesions
		Osteoma
		Osteoblastoma (Giant Osteoid Osteoma)
		Osteoclastoma (Giant Cell Tumor)
		Ossifying Fibroma
		Fibrous Dysplasia
		Osteosarcoma
	Conclusion
	References
Endoscopic Orbital Exenteration
	Examining Indications for Endoscopic-Assisted Orbital Exenteration
	Preoperative Assessment
	Endoscopic-Assisted Orbital Exenteration: Surgical Technique
	References
Part 6: Transorbital Techniques
Endoscopic Subperiosteal Abscess Drainage
	Clinical Presentation
	Management
	Surgical Management
	Conclusion
	References
Transorbital Techniques to Frontal Sinus Diseases
	Surgical Technique
		Soft-Tissue Exposure of the Frontoorbital Bone Complex
		Orbitofrontal Bone Window
	Management of Selected Targeted Disease
		Inverting Papilloma
		Meningocele With Cerebrospinal Fluid Leaks
			Transpalpebral Repair of Meningoceles and Cerebrospinal Fluid Leaks
			Transconjunctival Repair of Cerebrospinal Fluid Leaks
		Frontal Sinus Fractures
	Postoperative Management
	References
Endoscopic Management of Mucoceles With Significant Orbital Involvement
	Patient Demographics, Clinical Presentation, and Preoperative Workup
	Approaches
		Transnasal Endoscopic Approaches
		Transorbital Endoscopic Approaches
		External Approaches
	Complications and Pitfalls
	Conclusion
	References
Endoscopic Orbital Fracture Repair
	Medial Orbital Wall Fractures
	The Milan Approach to Medial Wall Orbital Fractures
		Technique
	Endoscopic Assistance for Complex Fractures or Management of Complications of Previous Conventional Fracture Treatment
	References
Part 7: Intracranial/Skull Base Surgery and the Optic Apparatus
Surgical Anatomy of the Optic Nerves and Chiasm
	Surgical Anatomy
		Anatomy of the Optic Chiasm
		Anatomy of the Intracranial Segment of the Optic Nerve
		Anatomy of the Intracanalicular Segment of the Optic Nerve
		Anatomy of the Intraorbital Segment of the Optic Nerve
	Conclusion
	References
Transcranial Approaches to the Optic Apparatus
	Choice of Approach: Supraorbital Versus Minipterional Versus Endonasal Versus Conventional Craniotomy
	Use of Supraorbital and Minipterional Approaches
		Indications and Choice of Approach
	Nuances of Endoscopy and Endoscope-Assisted Transcranial Tumor Removal
	Surgical Technique: General Room Setup and Essential Instrumentation for Keyhole Surgery in the Optic Apparatus Region
		Surgical Technique: Supraorbital Craniotomy
	Image 1 Case Examples
		Case 1
		Case 2
		Case 3
		Surgical Approach: Minipterional Craniotomy
	Image 2 Case Example
	Authors Experience
	Conclusion
	References
Endoscopic Endonasal Approaches to the Optic Apparatus: Technique and Pathology
	Pathology
		Pituitary Adenoma
		Meningioma
		Craniopharyngioma
		Rare Pathologies Affecting Optic Apparatus
	Clinical Features
	Surgical Treatment
		Preoperative Planning
		Equipment
		Intraoperative Setup
		Operative Technique
			The Endonasal Stage
			The Sphenoid Stage
			Cranial Base Stage
			Dural Stage
			Tumor Excision Stage
			Inspection Stage
			Dural Reconstruction Stage
			Closure
	Postoperative Management
	Postoperative Complications
	Visual Outcomes
	Advantages of the Endoscopic Endonasal Approach
	Limitations of the Endoscopic Endonasal Approach
	References
Reconstructive Techniques in Endoscopic Skull Base and Orbital Surgery
	Pre-Reconstruction Considerations
	The Reconstructive Ladder
		No Reconstruction
		Synthetic Dural Replacement Grafts
		Free Autografts
		Local Pedicled Flaps
		Regional Pedicled Flaps
		Free Tissue Transfer
	Special Considerations for Reconstruction of the Orbit
	Outcomes
	Conclusion
	References
Transorbital Endoscopic and Neuroendoscopic Surgery
	Indications and Contraindications
	Surgical Planning
	Surgical Technique
		Superior Approach
		Medial Approach
		Inferior Approach
		Lateral Approach
		Reconstruction of the Orbit and Adjacent Bone
	Postoperative Care
	Outcomes and Safety
	Conclusion
	References
Complications in Endoscopic Skull Base Surgery
	Minor Complications in Skull Base Surgery
		Major Complications in Skull Base Surgery
	Orbital Complications
	Conclusion
	References
Neuromonitoring in Endoscopic Skull Base Surgery
	Introduction
	Neuromonitoring Modalities
		Electromyography (EMG)
		Somatosensory Evoked Potentials (SSEP)
		Brainstem Auditory Evoked Potentials (BAEP)
		Visual Evoked Potentials (VEP)
	Extraocular Muscle Monitoring
		Anatomy
		Intraoperative Technique
		Clinical Evidence
	Case Example #1
	Case Example #2
	Case Example #3
	Conclusion
	References
Index
Inside Back Cover