Transnasal endoscopic approach for orbital apical cavernous hemangiomas:a case report

Cavernous hemangioma is the most primary benign orbital tumor in adults,and majority of cases could be easily settled by surgical treatment.However,cavernous hemangioma lodged deep in the orbital apex remained a challenge because the surgery may pose a high risk of injury to the optic nerve and significant visual loss.This presentation would report a case of cavernous hemangioma located in orbital apex who presented superonasal and inferotemporal peripheral vision defect.The patient received fully transnasal endoscopic surgery,and a 2 cm×1.5 cm tumor was successfully removed from the left orbital apex.The treatment results were satisfactory,with no after-effects and adverse reactions during follow-up.This case highlighted that transnasal endoscopic surgery is a promising technique for cavernous hemangiomas that are located deep in orbital apex.This approach provides direct pathway to tumor with limiting morbidity,maximal surgical field and ample illumination.The procedure represents a safe and less invasive management.

Endoscopic transnasal canaliculorhinostomy for refractory common canalicular obstruction with an unidentifiable lacrimal sac

AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal sac.METHODS:The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed.RESULTS:Fifty-six patients(56 eyes)with refractory CCO were recruited into the study.Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration.The anatomic and functional success rates were both 85.4%(41/48)at a mean follow-up of 18.6 mo.Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation.Postoperative complications included mild nasal bleeding in 5 cases,dried nasal feeling in 8 cases,and olfactory dysfunction in 4 cases.CONCLUSION:Although being surgically challenging,ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy(CDCR)with Jones tube.And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.

Modified endoscopic transnasal orbital apex decompression in dysthyroid optic neuropathy

Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.

Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients

Background The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. Methods Totally 49 patients, involving 46 （93.9%） being American Society of Anesthesiologists Physical Status （ASA-PS） grade III （n=3） and grade IV （n=-43）, in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. Results The tube was placed at or beyond the Treitz＇s ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 （93.9%） cases by transnasal method and 3 （6.1%） cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was （6.2±5.6） minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was （12.3±2.1） minutes. In the period of nasoenteral tube placement, the average systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and average pulse oxygen saturation （SpO2） did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. Conclusion The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.