Resection of a Fronto-orbital Skull Base Tumor and Subsequent Orbital Wall Reconstruction Using Navigational Planning and Guidance

Introduction: Ossifying fibroma is a rare tumor entity commonly found in the mandible. When located in the paranasal sinuses, complete en bloc excision is required to prevent recurrence. Sinonasal endoscopic management is possible in small tumors. In huge tumors, localization is difficult. This in turn may require an extensive surgical approach with significant bone deformity. We outline the clinical advantages of an image-guided fronto-orbitozygomatic craniotomy and a navigation-assisted orbital wall reconstruction in frontobasal giant ossifying fibromas.

Material and Methods: Our experience includes a patient with a giant ossifying fibroma located at the left frontobasis with involvement of the left ethmoid sinus and medial orbital wall leading to exophthalmos and impaired vision. The patient was scheduled for image-guided surgery by use of a wireless passive infrared surgical navigation system (VectorVisionTM, BrainLAB).

Results: After fronto-orbital approach the tumor margins were located by navigational guidance. Minimally invasive removal was performed. Primary reconstruction of the left medial orbital wall was performed by image guidance with calvarial bone. Bone chips were implanted following an accurate preoperative treatment plan. No major peri- or postoperative complications were observed. Postoperative imaging scans revealed no recurrent tumor progress.

Conclusions: Traditional surgical approaches to frontal skull base tumors are accompanied by a significant morbidity. Image-guidance allows a minimized approach. Furthermore, image-guided reconstruction of the medial orbital wall following a preoperative plan provides safe and accurate surgical treatment.