Surgical Treatment of Orbital Tumors at a Single Institution

  • Park, Hyun-Joon (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Yang, Seung-Ho (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Il-Sup (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Sung, Jae-Hoon (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Son, Byung-Chul (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Sang-Won (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine)
  • Published : 2008.09.28

Abstract

Objective : The authors reviewed the experience of 19 patients with orbital tumors and summarize the clinical features, surgical treatment and outcomes. Methods : The authors searched the database for all patients who underwent surgery for the treatment of orbital tumors at a single institution between 1999 and 2007. Data from clinical notes, surgical reports, and radiological findings were obtained for the analysis. Results : Orbital tumors constituted a heterogenous array of histopathology. The presenting symptoms were exophthalmos (52.6%), visual disturbance (26.3%) and pain (21.1%). The surgical approaches used were transcranial in 17 patients. Tumors located in the intraconal or perioptic space were surgically excised using a frontoorbital approach (8 cases). while pterional (3 cases). orbital (2 cases) and combined approaches (6 cases) were used for tumors in other sites. Total resection of tumors was achieved in 12 of 19 patients. In 4 patients with glioma and lymphoma only diagnostic biopsy was done. Three patients experienced visual deterioration postoperatively. Two patients had temporary diplopia, and one patient had temporary ptosis. Conclusion : Surgical treatment could be the mainstay of therapy for the majority of symptomatic orbital tumors. Many orbital tumors can be treated safely via a transcranial approach. Frontoorbital approach allows the surgeon to reach both the intraorbital and intracranial structures. Knowledge of the microanatomy of the orbit and meticulous surgical skills are necessary to overcome the pitfalls of intraorbital surgery.

Keywords

References

  1. Al-Mefty O, Fox JL : Supralateral orbital exposure and reconstruction. Surg Neurol 23 : 609-613, 1985 https://doi.org/10.1016/0090-3019(85)90012-6
  2. Badie B : Neurosurgical Operative Atlas, ed 2. New York : Thieme, 2007, pp270-288
  3. Bejjani GK, Cockerham KP, Kennerdel JS, Maroon JC : A reappraisal of surgery for orbital tumors. Part I : extracranial approaches. Neurosurg Focus 10 : E2, 2001
  4. Darsaut TE, Lanzino G, Lopes MB, Newman S : An introductory overview of obirtal tumors. Neurosurg Focus 10 : E1, 2001
  5. Delfini R, Raco A, Artico M, Salvati M, Ciappetta P : A two-step supraorbital approach to lesions of the orbital apex: technical note. J Neurosurg 77 : 959-961, 1992 https://doi.org/10.3171/jns.1992.77.6.0959
  6. Frazier CH : An approach to the hypophysis through the anterior cranial fossa. Ann Surg 57 : 145-150, 1913 https://doi.org/10.1097/00000658-191302000-00001
  7. Hejazi N : Frameless image-guided neuronavigation in orbital surgery : practical applications. Neurosurg Rev 29 : 118-122, 2006 https://doi.org/10.1007/s10143-005-0007-3
  8. Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB : The supraorbital approach : technical note. Neurosurgery 11 : 537-542, 1982 https://doi.org/10.1227/00006123-198210000-00016
  9. Kang JK, Lee IW, Jeun SS, Choi YK, Jung CK, Yang JH, et al : Tumors of the orbit : pitfalls of the surgical approach in 37 children with orbital tumor. Childs Nerv Syst 13 : 536-541, 1997 https://doi.org/10.1007/s003810050133
  10. Kennerdell JS, Maroon JC, Malton ML : Surgical approaches to orbital tumors. Clin Plast Surg 15 : 273-282, 1988
  11. MacCarty CS, Brown DN : Orbital tumors in children. Clin Neurosurg 11 : 76-93,1964
  12. Margalit N, Ezer H, Fliss DM, Naftaliev E, Nosek E, Kesler A : Orbital tumors treatedusing transcranial approches: surgical technique and neuroopthalmogical results in 41patients. Neurosurg Focus 23 : E11, 2007
  13. Maroon JC, Kennerdell JS : Surgical approaches to the orbit : indications and technique. J Neurosurg 60 : 1226-1235, 1984 https://doi.org/10.3171/jns.1984.60.6.1226
  14. Schmidek HH, Sweet WH : Operative Neurosurgical Techniques : Indication, Methods, and Results, ed 4. Philadelphia : WB Saunders Co., 2000, pp198-262
  15. Raimondi AJ : Pediatric Neurosurgery, ed 2. New York : Springer- Verlag, 1998, pp194-205
  16. Reinges MH, Nguyen HH, Krings T, Hutter BO, Rohde V, Gilsbach JM : Course of brain shift during microsurgical resection of supratentorial cerebral lesions : limits of conventional neuronavigation. Acta Neurochir (Wien) 146 : 369-377; discussion 377, 2004 https://doi.org/10.1007/s00701-003-0204-1
  17. Youmans JR : Neurological Surgery, ed 5. Philadelphia : WB Saunders Co., 2004, pp1317-1381
  18. Wilson WB, Gordon M, Lehman RA : Meningiomas confined to the optic cancal and foramina. Surg Neurol 12 : 21-28, 1979