Solitary fibrous tumors are rare mesenchymal tumors that may involve the orbit. Orbital solitary fibrous tumors are generally removed via an external orbitotomy. A 64-year-old woman with a history of breast cancer was examined for a 6-month history of gradual painless loss of vision in the right eye and evidence of a retrobulbar optic neuropathy. Imaging revealed a posterior medial orbital mass. Initial endoscopic biopsy demonstrated histopathologic changes consistent with a solitary fibrous tumor. The patient subsequently underwent an image-guided, transnasal, endoscopic resection of the tumor using the LandmarX system (Medtronics, Minneapolis, MN, U.S.A.). Three weeks after surgery, her visual acuity and visual field had returned to normal, and they remained normal for 2 years with no neuroimaging evidence of recurrent tumor. The transnasal endoscopic technique is useful in both biopsy and removal of posterior medial orbital lesions, particularly when a computer-assisted image guidance system is used. This approach should be added to the armamentarium of surgical approaches to orbital lesions.
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