Insights on the Surgical Management of Primary Intraorbital Tumors: A Case Series

Aim: The management of primary intraorbital tumors represents a small contingent of the neurosurgeon's armamentarium, in a context of great functional and aesthetic impact. Our aim is to present a case series from a single-center experience focusing on the clinical, radiological, and surgical aspects, underlining the follow-up particularities, and reviewing the literature in this distinctive field. Methods: The records of 22 patients diagnosed with intraorbital tumors (2011–2015) were retrospectively reviewed. Thirteen cases of intracranial tumors with secondary orbital extension were excluded. Nine cases of primary intraorbital tumors were selected for analysis of the clinical presentation, surgical management, and follow-up. The results were compared with a review of the available literature. Results: All nine cases (five men, four women, mean age: 57.3 years) were classified according to the anatomic localization of the lesion (66.6% in the supero-external orbital quadrant) and the clinical presentation. All patients were symptomatic, most frequently with exophtalmia (66.6%), decreased vision (33.3%), or diplopia (22%). A combined transcranial orbitotomy approach was used in eight out of the nine cases. Gross total resection was achieved in seven cases (77.7%). The primary intraorbital tumors were heterogeneous in origin: cavernous hemangioma (two cases), epidermal cyst (two cases), and individual cases of dacryoadenitis, angioleiomyoma, small B cell lymphoma, meningioma, and nonspecific inflammatory lesion. The mean follow-up was 10 months (range: 3–15), always in conjunction with a control MRI. No recurrence was recorded and the two cases of subtotal resection remained stable. Complete resolution of the symptoms was recorded in 77.7% (7/9 cases). The most frequent postoperative complications were transitory diplopia or ptosis (22%). Two cases presented a permanent deficit: reactive mydriasis and third nerve palsy, respectively. Conclusion: Complete resection of primary intraorbital tumors is indicated in symptomatic patients or in radiologic progression. It can be achieved with good functional and cosmetic results. Possible complications are related to the manipulation of nerve structures, especially of oculomotor fibers and less of parasympathetic fibers. The available literature underlines the importance of anatomic dissection and total resection, for a safe and effective surgical outcome. A national database for intraorbital tumors could be beneficial for future improvement in their management.