Endonasal, microsurgical approach to the retrobulbar region exemplified by intraconal hemangioma

The posterior orbit contain's a number of important and vulnerable structures, including the optic nerve, the opthalmic artery and vein, the ocular muscles and their motor nerves. Because of their close relation to the ocular bult, surgical access to this region is very difficult. Transfrontal, transfrontal-ethmoidal and transmaxillary procedures have the disadvantage of possible injury to a number of non-tumor affected structures. The endonasal microsurgical transethmoid access is described here along with a case report of a 2 x 1 cm intraconal hemangioma. Ethmoidectomy was performed after septal mobilization. The optic nerve was identified in the wall of the sphenoid sinus. The lamina papyracea was resected between the sphenoid sinus wall, skull base and ethmoid. The medial rectus muscle was mobilized after slitting open the periorbita to expose tumor. The hemangioma was then removed in toto under microscopic control. Surgery in the retrobulbar region could be performed gently and under microscopic magnification with this technique. The procedure used has a minor risk in the hands of an experienced nasalsurgeon and opens up new possibilities for the treatment of retroorbital lesions.