• Baskaran Ketharanathan, Mikkel Schou Andersen, Christian Bonde Pedersen, Peter Darling, John Jakobsen, Laleh Dehghani Molander, Rikke Hedegaard Dahlrot, Nina Nguyen, Frantz Rom Poulsen, and Bo Halle.
• Department of Neurosurgery, Odense University Hospital, Odense, Denmark. Electronic address: Baskaran.ketharanathan@rsyd.dk.
• World Neurosurg. 2022 Jun 1; 162: 85-90.

ObjectiveThe endoscopic endonasal approach (EEA) was originally performed to treat thyroid orbitopathy and proptosis. Since then, this approach also has been used to treat other causes of proptosis. This review systematically identifies surgical outcome and complication rates in patients without thyroid proptosis who underwent endoscopic endonasal orbital decompression.MethodsDatabases were searched using the following search terms: orbital disease, surgical decompression, and endoscopic endonasal approach. Two independent reviewers screened all abstracts and titles for relevance and all articles passing this screen were subjected to full-text review. To assess risk of bias, we used ROBINS-I (Risk Of Bias in Non-randomized Studies-of Interventions).ResultsEight studies with a total of 74 patients with nonthyroid proptosis were included. Pre- and postoperative eye examination was performed in all studies, but the extent of examination was varying. With a mean age of 35.7 years, most patients were adolescent, and most pathologies induced unilateral proptosis Complications to EEA for orbital decompression were transient diplopia (5 patients/6.8%), transient facial dysesthesia (2 patients/2.7%), ptosis (1 patient/1.4%), infarction (1 patient/1.4%), sinus obstruction (1 patient/1.4%), and enophtalmos (1 patient/1.4%). The authors reported successful reduction of proptosis in all but 2 patients (97.2%), and only 2 authors reported a need for secondary decompression.ConclusionsMedial orbital decompression using EEA is a feasible approach for orbital decompression in patients with nonthyroid proptosis. While being comparable in primary outcome to transorbital approaches, the EEA seems superior in terms of complication rates.Copyright © 2022 Elsevier Inc. All rights reserved.

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