Development of the international orbital Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system

El Rassi E 1 , Adappa ND 2 , Battaglia P 3 , Castelnuovo P 3 , Dallan I 4 , Freitag SK 5 Show all authors , Gardner PA 6 , Lenzi R 7 , Lubbe D 8 , Metson R 9 , Moe KS 10 , Muscatello L 7 , Mustak H 11 , Nogueira JF 12 , Palmer JN 2 , Prepageran N 13 , Ramakirshnan VR 14 , Sacks R 15 , Snyderman CH 16 , Stefko ST 17 , Turri-Zanoni M 3 , Wang EW 16 , Zhou B 18 , Bleier BS 9

Affiliations 

  • 1 Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK
  • 2 Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
  • 3 Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRc), University of Insubria, Varese, Italy
  • 4 Ear, Nose, and Throat (ENT), Audiology, and Phoniatrics Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
  • 5 Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
  • 6 Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • 7 Unit of Otorhinolaryngology, Azienda Unità Sanitaria Locale Toscana Nord Ovest-Apuane Hospital, Massa, Italy
  • 8 Department of Otolaryngology, University of Cape Town, Cape Town, South Africa
  • 9 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
  • 10 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Washington School of Medicine, Seattle, WA
  • 11 Oculoplastics and Orbital Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
  • 12 Sinus & Oto Centro-Hospital Geral de Fortaleza, Fortaleza, Brazil
  • 13 Department of Otorhinolaryngology-Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
  • 14 Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
  • 15 Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
  • 16 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • 17 Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • 18 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
Int Forum Allergy Rhinol, 2019 07;9(7):804-812.
PMID: 30809970 DOI: 10.1002/alr.22316

Abstract

BACKGROUND: Orbital cavernous hemangiomas (OCH) are the most common adult orbital tumor and represent an ideal index lesion for endonasal orbital tumor surgery. In order to standardize outcomes reporting, an anatomic-based staging system was developed.

METHODS: An international, multidisciplinary panel of 23 experts in orbital tumor surgery was formed. A modified Delphi method was used to develop the cavernous hemangioma exclusively endonasal resection (CHEER) staging system with a total of 2 rounds being completed.

RESULTS: Tumors medial to a plane along the long axis of the optic nerve may be considered amenable for an exclusively endonasal resection. In select cases, tumors may extend inferolaterally if the tumor remains below a plane from the contralateral naris through the long axis of the optic nerve (ie, plane of resectability [POR]). This definition reached consensus with 91.3% of panelists in agreement. Five stages were designed based on increasing technical resection difficulty and potential for morbidity. Stages were based on the relationship of the tumor to the extraocular muscles, the inferomedial muscular trunk of the ophthalmic artery (IMT), and orbital foramina. Staging by anatomic location also reached consensus with 87.0% of panelists in agreement. Size was not included in the staging system due to the lack of agreement on the contribution of size to resection difficulty.

CONCLUSION: Endoscopic orbital tumor surgery is a nascent field with a growing, yet heterogeneous, body of literature. The CHEER staging system is designed to facilitate international, high-quality, standardized studies establishing the safety, efficacy, and outcomes of endonasal resection of OCH.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications