The endonasal microsurgical approach to the vetrobulbar region for the treatment of an intraconal hemangioma

The posterior orbit contain's a number of important and vulnerable structur es, including the optic nerve, the opthalmic artery and vein,the ocular mus cles and their motor nerves. Because of their close relation to the ocular bult, surgical access to this region is very difficult. Transfrontal, trans frontal-ethmoidal and transmaxillary procedures have the disadvantage of po ssible injury to a number of non-tumor affected structures. The endonasal m icrosurgical transethmoid access is described here along with a case report of a 2x1 cm intraconal hemangioma. Ethmoidectomy was performed after septa l mobilization. The optic nerve was identified in the wall of the sphenoid sinus. The lamina papyracea was resected between the sphenoid sinus wall, s kull base and ethmoid. The medial rectus muscle was mobilized after slittin g open the periorbita to expose tumor. The hemangioma was then removed in t ote under microscopic cont retrobulbar region could be performed gently and under microscopic magnification with this technique. The procedure used ha s a minor risk in the hands of an experienced nasalsurgeon and opens up new possibilities for the treatment of retroorbital lesions.