Transorbital endoscopic removal of posterior lateral orbital mass.

INTRODUCTION Numerous endoscopic approaches to the orbit have been described in the literature and are typically performed using a transnasal route. These techniques are especially useful for medial orbital masses. Pathology located within the posterior and posterior-lateral orbit can create additional challenges for surgical access. Approaches for these hard-to-reach lesions include more invasive surgical corridors such as anterior and lateral orbitotomy as well as orbitozygomatic or frontal keyhole craniotomy. The endoscopic approach has proven useful to biopsy masses in this location, yet complete resection using endoscopic techniques has not been undertaken to date. We present a case of a posterior lateral orbital tumor where lesion location delivers classic surgical challenges for its removal. To avoid a craniotomy, large lateral wall orbitotomy, prolonged postoperative pain, or possible an aesthetically unappealing skin incision, we used a unique direct transorbital endoscopic approach (modified transorbital neuroendoscopic surgery [TONES]) to achieve a complete en bloc excision of this tumor. To our knowledge, this is the first time this adaptation of the endoscopic technique for a complete orbital tumor resection has been described.