Surgical Techniques and the Choice of Operative Approach for Cranioorbital LesionsFunding This study was funded by The Science and Technology Project of Guangdong Province (NO: 2015A020212016 and 2016A020214007); The Science and Technology Program of Guangzhou (NO: 201604020080), China.
08. März 2019
28. Juli 2019
04. September 2019 (online)
Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes.
Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed.
Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3.
Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.
Keywordscranioorbital lesion - operative approach - microsurgery - supraorbital - eyebrow - approach - pterional approach
* Equal contributors: Haiyong He, Meiqin Cai, and Manting Li.
- 1 Welkoborsky HJ, Plontke SK. [Possible surgical approaches to the orbit]. HNO 2018; 66 (11) 812-826
- 2 Jian T, Sun F, Tang D, Wang S, Wu T, Zhao L. Clinical analysis of transcranial orbitotomy approach on cranio-orbital tumors. J Craniofac Surg 2015; 26 (02) 441-446
- 3 Rana M, Holtmann H, Lommen J. , et al. Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation. J Craniomaxillofac Surg 2018; 46 (06) 994-1000
- 4 Pai SB, Nagarjun MN. A neurosurgical perspective to approaches to the orbit: A cadaveric study. Neurol India 2017; 65 (05) 1094-1101
- 5 Hodaj I, Kutlay M, Gonul E. , et al. The use of neuronavigation and intraoperative imaging systems in the surgical treatment of orbital tumors. Turk Neurosurg 2014; 24 (04) 549-557
- 6 Honavar SG, Manjandavida FP. Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016. Asia Pac J Ophthalmol (Phila) 2017; 6 (02) 153-158
- 7 Hiwatashi A, Togao O, Yamashita K. , et al. High resolution diffusion-weighted imaging for solitary orbital tumors : 3d turbo field echo with diffusion-sensitized driven-equilibrium (DSDE-TFE) preparation technique. Clin Neuroradiol 2018; 28 (02) 261-266
- 8 He H, Li W, Liang C. , et al. Eyebrow incision for combination supraorbital minicraniotomy with orbital osteotomy: application to cranio-orbital lesions. World Neurosurg 2018; 114: e631-e640
- 9 Kang JK, Lee IW, Jeun SS. , et al. Tumors of the orbit. Pitfalls of the surgical approach in 37 children with orbital tumor. Childs Nerv Syst 1997; 13 (10) 536-541
- 10 Talacchi A, De Carlo A, D'Agostino A, Nocini P. Surgical management of ocular symptoms in spheno-orbital meningiomas. Is orbital reconstruction really necessary?. Neurosurg Rev 2014; 37 (02) 301-309 , discussion 309–310
- 11 Hassan WM, Alfaar AS, Bakry MS, Ezzat S. Orbital tumors in USA: difference in survival patterns. Cancer Epidemiol 2014; 38 (05) 515-522
- 12 Wu T, Sun FY, Tang DR, Xu L. [The clinical analysis of cranio-orbital communicating tumors]. Zhonghua Yan Ke Za Zhi 2013; 49 (06) 531-535
- 13 Dallan I, Sellari-Franceschini S, Turri-Zanoni M. , et al. Endoscopic transorbital superior eyelid approach for the management of selected spheno-orbital meningiomas: preliminary experience. Oper Neurosurg (Hagerstown) 2018; 14 (03) 243-251
- 14 Civit T, Cophignon J. [Neurosurgical approaches to the orbit]. Neurochirurgie 2010; 56 (2,3): 218-229
- 15 McKinney KA, Snyderman CH, Carrau RL. , et al. Seeing the light: endoscopic endonasal intraconal orbital tumor surgery. Otolaryngol Head Neck Surg 2010; 143 (05) 699-701
- 16 Hassler W, Schick U. The supraorbital approach--a minimally invasive approach to the superior orbit. Acta Neurochir (Wien) 2009; 151 (06) 605-611 , discussion 611–612
- 17 Montano N, Lauretti L, D'Alessandris QG. , et al. Orbital tumors: report of 70 surgically treated cases. World Neurosurg 2018; 119: e449-e458
- 18 Gao D, Fei Z, Jiang X. , et al. The microsurgical treatment of cranio-orbital tumors assisted by intraoperative electrophysiologic monitoring and neuronavigation. Clin Neurol Neurosurg 2012; 114 (07) 891-896
- 19 Troude L, Bernard F, Roche PH. The medial orbito-frontal approach for orbital tumors: a How I Do It. Acta Neurochir (Wien) 2017; 159 (11) 2223-2227
- 20 Adawi MM, Abdelbaky AM. Validity of the lateral supraorbital approach as a minimally invasive corridor for orbital lesions. World Neurosurg 2015; 84 (03) 766-771
- 21 Xie Q, Wang DJ, Sun L. , et al. Minimal invasive trans-eyelid approach to anterior and middle skull base meningioma: a preliminary study of Shanghai Huashan hospital. Int J Clin Exp Med 2014; 7 (11) 3974-3982
- 22 Arai Y, Kawahara N, Yokoyama T, Oridate N. Endoscopic transnasal approach for orbital tumors: A report of four cases. Auris Nasus Larynx 2016; 43 (03) 353-358
- 23 Signorelli F, Anile C, Rigante M, Paludetti G, Pompucci A, Mangiola A. Endoscopic treatment of orbital tumors. World J Clin Cases 2015; 3 (03) 270-274
- 24 Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P. Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients. Br J Neurosurg 2013; 27 (01) 84-90
- 25 Ringel F, Cedzich C, Schramm J. Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 2007; 60 (04) (Suppl. 02) 214-221 , discussion 221–222
- 26 Freeman JL, Davern MS, Oushy S. , et al. Spheno-orbital meningiomas: a 16-year surgical experience. World Neurosurg 2017; 99: 369-380
- 27 Finger PT. Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects. Surv Ophthalmol 2009; 54 (05) 545-568
- 28 Saeed P, van Furth WR, Tanck M. , et al. Natural history of spheno-orbital meningiomas. Acta Neurochir (Wien) 2011; 153 (02) 395-402
- 29 Honig S, Trantakis C, Frerich B, Sterker I, Schober R, Meixensberger J. Spheno-orbital meningiomas: outcome after microsurgical treatment: a clinical review of 30 cases. Neurol Res 2010; 32 (03) 314-325
- 30 Liu Y, Ma JR, Xu XL. Transcranial surgery through pterional approach for removal of cranio-orbital tumors by an interdisciplinary team of nurosurgeons and ophthalmologists. Int J Ophthalmol 2012; 5 (02) 212-216
- 31 Cannon PS, Rutherford SA, Richardson PL, King A, Leatherbarrow B. The surgical management and outcomes for spheno-orbital meningiomas: a 7-year review of multi-disciplinary practice. Orbit 2009; 28 (06) 371-376