Objective This study aimed to objectively compare maneuverability at the contralateral medial orbit when approached through the traditional endoscopic endonasal approach (EEA) and EEA with transeptal window (TW).

Study Design Anatomic dissections were performed bilaterally on three latex-injected cadaveric heads. Approaches were performed sequentially; initially, an EEA was fashioned. Binostril access was achieved through a 2-cm posterior septectomy. The second stage pertained to the TW dissection. Area of exposure (AoE), surgical freedom (SF), and angles of attack (AoA) were measured along the contralateral medial orbital wall and compared for each approach. Additionally, the study presents an illustrative case describing the application of the EEA + TW for resection of an intraorbital schwannoma.

Results Compared with EEA, EEA + TW yielded a significantly greater AoE along the contralateral medial orbital wall (39.45 vs. 48.45 cm², respectively; p = 0.002). SF was statistically different between the EEA and EEA + TW (1153.25 vs. 2256.33 cm², respectively; p = 0.002). AoA in the horizontal plane were significantly broader with the EEA + TW (6.36 vs. 4.9 degrees by EEA; p = 0.015).

A 50-year-old male with a right medial extraconal orbital tumor was successfully treated through an EEA using the transeptal corridor to access the medial orbital region. No long-term complications were encountered after 31 months of follow-up.

Conclusions EEA + TW is a minimally invasive technique that maximizes exposure and maneuverability within the medial orbital wall, allowing resection of lesions that extend anteriorly. EEA + TW limits disruption of the nasal septum and overcomes the obstacle that intranasal anatomy represents for instrumentation.

目的 本研究旨在客观比较通过传统内镜鼻内入路 (EEA) 和带房间隔窗 (TW) 的 EEA 接近对侧内侧眼眶的可操作性。

研究设计 对三个注射乳胶的尸体头部进行双侧解剖。方法按顺序进行；最初，欧洲经济区成立。Binostril 通路是通过 2 厘米后鼻中隔切除术实现的。第二阶段涉及 TW 解剖。沿对侧眶内壁测量暴露面积 (AoE)、手术自由度 (SF) 和攻角 (AoA)，并针对每种入路进行比较。此外，该研究还提供了一个说明性案例，描述了 EEA + TW 在眶内神经鞘瘤切除术中的应用。

结果 与 EEA 相比，EEA + TW 沿对侧眶内壁产生的 AoE 显着更大（分别为 39.45 vs. 48.45 cm ²；p  = 0.002）。EEA 和 EEA + TW 之间的 SF 存在统计差异（分别为 1153.25 与 2256.33 cm ²；p  = 0.002）。EEA + TW 的水平面迎角明显更宽（EEA 为 6.36 度，EEA 为 4.9 度；p  = 0.015）。

一名 50 岁男性患有右内侧锥外眼眶肿瘤，通过 EEA 使用房间隔走廊进入内侧眼眶区域成功治疗。随访 31 个月后未出现长期并发症。

结论 EEA + TW 是一种微创技术，可最大程度地暴露眶内壁并提高其可操作性，从而可以切除向前延伸的病变。EEA + TW 限制了鼻中隔的破坏，并克服了鼻内解剖学对仪器仪表造成的障碍。