Surgical Corridors for Orbital Tumors: A “360-Degree—Round-the-Clock” Approach

Introduction: Orbital lesions often require challenging surgical procedures and a multidisciplinary approach. The availability of different surgical corridors allowing as a whole a 360 degrees access to the orbit is important to minimize the risk of neural and vascular injury in this area. We report our experience in the treatment of orbital tumors, selecting the surgical approach based on the anatomical location of the lesion.

Materials and Methods: From 2009 to December 2020, a total of 32 patients harboring primitive orbital tumors or intracranial tumors with secondary intra-orbital extension were surgically treated at our Department. The pathologies included 15 meningiomas with intra-orbital extension, 6 optic nerve gliomas and 11 pure intraorbital tumors. Preoperative coronal MRI and/or CT sequences were compared using a “360-degree model” of the orbit centered on the optic nerve. The extended endoscopic endonasal approach (EEEA) was used for lesions of the inferomedial quadrant of the orbit in 15 patients, the lateral micro-orbitotomy (LO) to access lateral lesions (7 patients) and the supraorbital keyhole (SKA) (4) or transconjunctival (TCJ) (3) approach to expose the superolateral quadrant of the orbit. Three patients were treated with combined EEEA-SKA.

Results: A gross total resection was achieved in 27 patients out of 32. In the remainder patients, the resection of the tumor was subtotal. Three patients treated with EEEA had post-operative CSF fistula, which required surgical repair, while other four patients presented respectively a transient deficit of the third and sixth cranial nerve.

Conclusion: The approaches described in our series, alone or combined, provide as a whole a 360 degrees access to the entire orbit. In our experience, the EEEA allows an excellent vision of the surgical area, a better resection and the decompression of the optic nerve. The optimal approach was selected in each case to avoid crossing the plane of the optic nerve and damaging eloquent structures.

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Artikel online veröffentlicht:
15. Februar 2022