J Neurol Surg B Skull Base 2016; 77 - FP-21-05
DOI: 10.1055/s-0036-1592546

The Lateral Orbitotomy Approach for Lesions Involving the Middle Fossa

Joseph D. Chabot 1, S. Tonya Stefko 2, Juan C. Fernandez-Miranda 1, Paul A. Gardner 1
  • 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • 2Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pittsburgh, Pennsylvania, United States

Objective: Classically used for treatment of orbital lesions, the lateral orbitotomy with cantholysis can be combined with a temporal craniectomy for lesions involving the middle cranial fossa. We present a single-center experience with the lateral orbitotomy approach for lesions involving the middle fossa.

Methods: Twenty-seven patients underwent lateral orbitotomies from April 2012 to October 2015. Excluding patients with solely intraorbital pathologies, 14 patients’ clinical and radiographic records were retrospectively reviewed.

Results: Signs/symptoms in the 14 patients (ages 28–81) included proptosis (79%), decreased visual acuity (46%), diplopia (57%), and afferent pupillary defect (69%). Pathologies were meningioma (9), esthesioneuroblastoma, lymphoma, chordoma, Ewing sarcoma, and squamous cell carcinoma. Surgical goals were maximal safe resection in nine patients, palliative debulking in three patients, and cavernous sinus (CS) biopsy in two patients. In nine patients for whom maximal resection was the goal, two had gross total resection, while seven had near-total resection. All patients (three) for whom palliation was the goal had symptomatic improvement. Both CS biopsies obtained diagnostic tissue without complications. All patients with proptosis (n = 11) and diplopia (n = 8), and 4 of 6 patients with decreased visual acuity had improvement in their symptoms. No patient reported worsening of their symptoms. Mean follow-up was 12 months (2–30 months). Complications included oculorrhea (1), pseudomeningocele (2), transient ptosis (2), and forehead numbness (1).

Conclusion: The lateral orbitotomy is a promising approach for select lesions with involvement of both the lateral orbit and middle cranial fossa. It provides minimally invasive access for biopsy, decompression, or resection.