PMC8377276_01
Preoperative enhanced MRI of the orbits (left, axial; right, coronal) showing the cavernous hemangioma located in the inferior lateral part of the right orbital intraconic space (A) and detail of tumor localization using navigation (B). Postoperative MRI showing complete removal of the hemangioma (C). The transpalpebral approach allows a minimally invasive access to the retro-orbital space ensuring excellent esthetic and functional results (D).
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F1
Postoperative MRI showed complete removal of the lesion (Figure 1C). The esthetic result for the patient was optimal (Figure 1D).
On the 55-inch monitor, the navigation device (A) and ultrasound probe (B) used for precise localization of the hemangioma inside the periorbita are clearly visible. The PiP mode (B) allows the surgeon to control the position of the ultrasound probe without having to look away from the operating field.
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F2
Minimally-invasive removal of the lesion was aided by the use of intraoperative navigation (electromagnetic StealthStation S8, Medtronic) and ultrasound (BK 5000 , BK Medical) in order to limit retraction on the ocular globe, and to reduce the incision of the periorbita and manipulation of intraconic structures within the periorbital fat (Figure 2).
Summary of the main surgical steps. Skin incision of the lower eyelid (A); localization of the hemangioma before the opening of the periorbit using navigation (B); localization of the hemangioma within the periorbit using ultrasound (C); blunt dissection and removal of the hemangioma (D).
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F3
The main steps of the surgical procedure are clearly visible in the attached Video as well as summarized in Figure 3.
Placement of the technologies in use (4K-3D camera, 55-inch monitor, navigator, and ultrasound) and staff within the OR during surgery for right transpalpebral approach (A) and scheme (B). Note the comfortable position of the surgeon who can operate while looking at the monitor with the head in an upright position.
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