Protective Silastic® sheet in combined transorbital and transnasal resection of sinonasal lesions

Background: Combined transorbital and transnasal endoscopic surgery for access to the skull base has contributed to the gradual expansion of the remit of the endoscopic skull base surgeon. Method: We present our technique of Silastic® sheet aided combined transorbital and transnasal endoscopic resection of anterior skull base malignancies, with a description of surgical technique and our method of safeguarding the orbital contents with appropriate suggested indications. Results: Patient underwent resection of non-intestinal type adenocarcinoma. There were no immediate or delayed postoperative complications related to transorbital access. Conclusion: In cases where tumour infiltrates medial orbital wall and there is an indication to remove the lamina papyracea and/ or periorbita, we find the initial transorbital approach advantageous to find a dissection plane in healthy tissue and to achieve partial devascularisation of tumour by cauterisation of anterior and posterior ethmoidal artery. Moreover, this approach can be combined with intraorbital placement of Silastick sheet to prevent a prolapse of orbital contents into the nasal cavity during transnasal resection which may lead to its damage.