J Neurol Surg B Skull Base 2016; 77 - FP-03-02
DOI: 10.1055/s-0036-1592448

Complex Orbital Tumors: Can Endoscopy Expand the Indications of Surgery or Improves the Standard Technique?

Lucia Di Somma 1, M. Re 2, P. Balercia 3, R. Girotto 3, Davide Nasi 1, Roberto Colasanti 1, A. Marini 1, G. Ghisellini 1, M. Scerrati 1
  • 1Clinica di Neurochirurgia, Università Politecnica delle Marche, Ospedali Riuniti, Ancona
  • 2U.O. di Orl. Università Politecnica delle Marche, Ospedali Riuniti, Ancona
  • 3U.O. di Maxillo-Facciale, Università Politecnica delle Marche, Ospedali Riuniti, Ancona

Introduction: Surgical approaches to orbital lesions represent challenging procedures that often require the combined effort of different specialists. Therefore, the preservation of function is a primary concern. To minimize the risk of injuring important neural and vascular structures in this area, surgical approaches must be available to provide 360 degrees of access to the orbit. In this background, the extended endoscopic endonasal approach (EEA) is reserved for lesions of the inferomedial quadrant of the orbit, the lateral micro-orbitotomy (LO) gives access to the lateral lesions while the supraorbital keyhole (SKA) or transconjunctival (TCJ) approach to the superolateral quadrant of the orbit.

Materials and Methods: From January 2008 to September 2013, a total of 18 patients harboring primitive orbital tumor or intracranial tumor with secondary intraorbital extensions were treated at our institution. Clinical presentation, pathology, and location in relation to the extraocular muscles were recorded. In addition, preoperative coronal MRI and/or CT views were compared using a “360-degree model” of the orbit with its center at the optic nerve. These lesions included seven meningiomas with intraorbital extension, three optic nerve glioma, and eight pure intraorbital tumors. The rationale for choosing a lateral, supra-orbital or medial endoscopic approaches is discussed for each case. 10 patients underwent to EEA, 3 patients to LO while the remainder patients were treated with SKA (2), TCJ (2) and with combined EEA-SKA (1).

Results: In all cases the lesion was exposed in all its extension. A gross total resection was achieved in 15 patients out of 18. In the remainder of patients, the resection of the tumor was subtotal. Two cases treated with EEA were complicated by post-operative CSF fistula (resolved by surgical repair), while other two patients presented respectively a transient deficit of the third and sixth cranial nerve.

Conclusion: The approaches described in this series, alone or combined, provide 360 degrees of access to the entire orbit. The choice of the optimal approach guided primarily by the avoidance of crossing the plane of the optic nerve.