A patient with previous frontal surgery has progressive proptosis. CT shows an expansile frontal lesion with bony remodelling extending far lateral to the orbit. What most determines surgical access?
Extent, lateral reach, prior scarring and orbital/intracranial complications determine endoscopic, trephine, combined or open access.
A. Whether the lesion and its drainage pathway are safely reachable endonasally: Extent, lateral reach, prior scarring and orbital/intracranial complications determine endoscopic, trephine, combined or open access.
B. Bony erosion alone mandates craniotomy: Remodelling/erosion does not by itself determine the route.
C. All mucoceles require external frontoethmoidectomy: Many are successfully marsupialised endoscopically.
D. Antibiotics alone: They may treat superinfection but not a closed expansile cavity.
E. Proptosis without visual loss permits indefinite delay: Vision can deteriorate and specialist assessment remains urgent.
If visual acuity were falling or an RAPD appeared, urgent decompression would take priority over elective route optimisation.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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