Transnasal endoscopic removal of an orbital cavernoma

The approach to posterior and medial orbital tumors is still a challenge, s ince poor functional results are frequent. We report a case of cavernoma su ccessfully removed by a modified transnasal endoscopic procedure. The patie nt, a 56-year-old woman, complained of a decrease in vision of the left eye . Magnetic resonance imaging evidenced a lesion in the posterior part of th e orbital cavity, inferior to the optic nerve, extending to the sphenoidal cleft. The lesion was isodense on T1-weighted images and showed contrast en hancement. Because of the medial location of the tumor, the patient was ref erred to the otolaryngology department by the neurosurgeons, and a transnas al endoscopic approach was chosen. A large exposure of the operative field was obtained, and a cavernoma was removed. Rapid relief of the symptoms was obtained. In view of this good result, we advocate the transnasal endoscop ic approach in cases of inferomedial and posterior intraconal lesions as an alternative and addition to the standard techniques of orbital surgery.