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Endoscopic transnasal image-guided approach to diagnosis in orbital apex and optic canal lesions

Published online by Cambridge University Press:  04 July 2019

S N Unadkat ,
C E Rennie  and
W E Grant
S N Unadkat*
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
C E Rennie
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
W E Grant
Affiliation:
Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Author for correspondence: Mr Samit N Unadkat, Department of Otolaryngology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK E-mail: s.unadkat@nhs.net Fax: +44 (0)20 3312 1847
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Abstract

Objective

Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken.

Methods

Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance.

Results

Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa–Hunt syndrome cases.

Conclusion

A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.

Keywords

Orbital PseudotumorCranial Fossa, AnteriorTolosa-Hunt SyndromeImage-Guided BiopsyCerebrospinal Fluid Leak
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 6 , June 2019 , pp. 501 - 507
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Mr S N Unadkat takes responsibility for the integrity of the content of the paper

Presented orally at the European Rhinologic Society, 22–26 April 2018, London, UK.

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