Sinonasal Tumors

Transorbital neuroendoscopic surgery was first described as a unilateral or bilateral endoscopic portal for approaching various skull base locations and pathologies. There are four transorbital approaches, each with distinct advantages to various sinonasal and skull base locations including the frontal sinus, the interorbital anterior cranial fossa (e.g., ethmoid skull base), middle cranial fossa, orbit, orbital apex, and beyond. A variety of tumors that originate in the nose and sinuses can be challenging to visualize and instrument with transnasal techniques alone. Furthermore, the paranasal sinuses are an anatomic space with unique physiologic activity (e.g., smell, mucus production, nasal airflow, etc.) and relationships (e.g., skull base) that must be considered when choosing a surgical strategy. We describe how the addition of a transorbital approach to sinonasal tumor management, for both benign and malignant, can aid in access and allow for gross total and oncologically sound resections.