Head & Neck Institute Outcomes

Cleveland Clinic surgeons have published the world’s largest single center experience to date on an innovative endoscopic endonasal approach (EEA) for removing or sampling orbital tumors isolated in the intraconal space. The research was recently published in the Laryngoscope.

The 13 men and 7 women followed in the published series of consecutive patients underwent procedures between January 2014 and December 2021. All had rare lesions limited to the medial intraconal space detected following visual symptoms (visual loss, diplopia, and/or orbital pain). Half of the procedures were performed for complete resection through two nostrils and the other half, when malignancy was suspected, were biopsies taken through a single nostril approach. The tumor types encountered included 6 cavernous hemangiomas, 4 schwannomas, 4 lymphomas, 2 inflammatory pseudotumors, 2 chronic invasive fungal sinusitides, and 2 metastases.

Drs. Sindwani and Recinos performed all 20 procedures using the multi-handed approach popularized for endoscopic skull base surgery by utilizing an endonasal corridor between the medial and inferior rectus muscles. They were able to achieve gross total resection (GTR) in 9 of the 10 benign lesions and obtained conclusive pathologic diagnoses in all 10 of the planned biopsies. No orbital reconstruction was required. There were no visual changes in the patients following the 10 biopsies. Among the 10 planned resection cases, visual acuity returned to normal in 8 with no change in the other 2. All of the resection patients experienced some transient postoperative diplopia, but this resolved by 3 months in 9 patients, while the tenth was lost to follow up. Although the primary goal of the surgery is to prevent further visual decline, some patients noted dramatic improvements in their vision even when it had been affected for some time.

The results of this study demonstrate that in the hands of an experienced skull base team, the EEA is effective for accessing lesions in the medial intraconal space and affords excellent outcomes with minimal postoperative morbidity.