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172

KUANetal.

TABLE XVIII.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

1. 45% with intracranial extension 2. 36% of patients with preoperative complications (two

Assess

Wardinsky et al. 885

1991

4

Retrospective case series

Patients with nasal

frequently of intracranial extension and preoperative complications

dermoids, 10-year cohort at a single institution ( n = 22)

with meningitis, two osteomyelitis, seven cellulitis/abscess)

Abbreviation: CMNMs, congenital midline nasal masses.

TABLE XIX.A.1 Overview of CHEER staging and ORBIT classification systems. Stage/Class CHEER Anatomic Description

ORBIT Anatomic Description

I

Extraconal OCH

Extraconal

II

Intraconal OCH anterior to the inferomedial muscular trunk of the ophthalmic artery and inferior to the horizontal axis of the medial rectus Intraconal OCH anterior to the inferomedial muscular trunk of the ophthalmic artery and superior to the horizontal axis of the medial rectus IVA: Intraconal OCH posterior to the inferomedial muscular trunk of the ophthalmic artery without extension into the optic canal IVB: Intraconal OCH posterior to the inferomedial muscular trunk of the ophthalmic artery with extension into the optic canal or an isolated OCH within the optic canal VA: Extraconal or intraconal OCH with pterygopalatine and/or infratemporal fossa extension through the inferior orbital fissure

Intraconal and anterior to the intersection of the ophthalmic artery and optic nerve

Intraconal and posterior to the intersection of the ophthalmic artery and optic nerve

III

IV

Extraconal or intraconal with extension into the pterygopalatine and/or infratemporal fossae through the inferior orbital fissure

Extraconal or intraconal with intracranial extension through the superior orbital fissure

V

VB: Extraconal or intraconal OCH with intracranial extension through the superior orbital fissure Abbreviations: CHEER, Cavernous Hemangioma Exclusively Endonasal Resection; OCH, orbital cavernous hemangioma; ORBIT, Orbital Resection By Intranasal Technique.

communication between multidisciplinary teams and standardize surgical candidacy, tumor extent, and out comes reporting. The Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system for OCHs was developed in 2019 by an international multidisci plinary panel, based on tumor location relative to critical intraconal structures. Selected tumors located medial to the optic nerve and/or inferior to the plane of resectabil ity (intraconal orbital surgery) were defined as candi dates for endoscopic resection. 911 In an attempt to extend the accumulated knowledge obtained from endoscopic orbital cavernous hemangioma (OCH) resection to include all benign tumors, the ORBIT classification system was then introduced to define the surgical complexity of both endoscopic resection and combined open and endo scopic resection for any benign primary orbital lesion (Table XIX.A.1). 912 1

Efficacy of tumor resection Tailoring the appropriate approach based on tumor loca tion and characteristics is the key to safe and efficacious treatment (Table XIX.A.2). Continued development and refinement of surgical techniques enable the use of 360 ◦ approaches based on the endoscopic endonasal corri dor. Thus, coupling transnasal endoscopic orbit surgery with transconjunctival, transorbital/transcaruncular, lat eral orbitotomy, or craniotomy approaches can extend the boundaries of reach to various ORBIT classes with decreased morbidity. A transcaruncular approach can sup plement EEA to gain additional access to the medial orbit and for fat retraction and lateral tumor surface dissec tion. For intraorbital neoplasms located lateral to the optic nerve, the transorbital endoscopic approach represents the less invasive route to perform biopsies, debulking, or complete removal of lesions. 910,913,914