Endoscopic transnasal cryo-assisted removal of orbital cavernous hemangiomas: case report and technical hints.

Endoscopic transnasal cryo-assisted removal of orbital cavernous hemangiomas: case report and technical hints.

World Neurosurg. 2019 Feb 13;:

Authors: Castelnuovo P, Arosio AD, Leone F, Ravasio A, Azzolini C, De Maria F, Pistochini A, Volpi L, Bignami M

Abstract
BACKGROUNDS: Cryoprobe devices are used by ophthalmic and orbital surgeons for the extraction of fluid-filled intraorbital lesions. No series described cryo-dissection via an exclusive transnasal approach. The authors describe two cases of purely endoscopic transnasal removal of intraconal orbital hemangiomas with the aid of a dedicated cryoprobe.
METHODS: All the transnasal endoscopic intraorbital procedures were collected and analyzed. The cases in which the intraorbital dissection was performed with the use of Optikon® Cryo-line probe were considered, analyzing clinical features, histology, size and location of the lesion, early and late complications, time of the surgical procedures and hospital stay. Patients were followed up with endoscopic endonasal evaluations performed at 2, 4 and 8 weeks after surgery and with ophthalmologic and orthoptic evaluations performed 2 days and 2 months after the surgery.
RESULTS: Two transnasal intraorbital endoscopic procedures with the aid of the dedicated cryo-line probe were collected. The lesions were located in the intraconal space, medial to the optic nerve. In both of the patients the histological evaluation was compatible with cavernous hemangioma and a complete resection was obtained. Mean hospital stay was 5.5 days. The two months post-operative ophthalmologic and orthoptic evaluations revealed complete resolution of the preoperative symptoms complained.
CONCLUSIONS: Cryoprobes represent an adjunctive tool in the orbital surgeons' armamentarium, useful in the extraction of fluid-filled intraorbital lesions. This preliminary experience suggests that their use can ease the removal of intraconal hemangiomas with exclusive transnasal approach. The analysis of further cases is necessary to confirm safety and efficacy.

PMID: 30771539 [PubMed - as supplied by publisher]

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