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Clinical and ophthalmological outcome of endoscopic transorbital surgery for cranioorbital tumors

 Doo-Sik Kong  ;  Stephanie Ming Young  ;  Chang-Ki Hong  ;  Yoon-Duck Kim  ;  Sang Duk Hong  ;  Jung Won Choi  ;  Ho Jun Seol  ;  Jung-Il Lee  ;  Hyung Jin Shin  ;  Do-Hyun Nam  ;  Kyung In Woo 
 JOURNAL OF NEUROSURGERY, Vol.131(3) : 667-675, 2019 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Cohort Studies ; Endoscopy/methods* ; Eye Diseases/diagnosis ; Eye Diseases/etiology ; Eye Diseases/prevention & control* ; Eyelids/surgery ; Female ; Frontal Bone* ; Humans ; Male ; Middle Aged ; Orbital Neoplasms/complications ; Orbital Neoplasms/pathology ; Orbital Neoplasms/surgery* ; Sphenoid Bone* ; Treatment Outcome ; Young Adult
EOM = extraocular motility ; GTR = gross-total resection ; NTR = near-total resection ; STR = subtotal tumor resection ; TOA = transorbital approach ; cranioorbital tumor ; endoscopic ; oncology ; transorbital surgery
OBJECTIVE: Cranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment. METHODS: The authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017. There were 12 patients with sphenoorbital meningiomas. Other lesions included osteosarcoma, plasmacytoma, sebaceous gland carcinoma, intraconal schwannoma, cystic teratoma, and fibrous dysplasia. Ten patients had primary lesions and 8 patients had recurrent tumors. Thirteen patients had intradural lesions, while 5 had only extradural lesions. RESULTS: Of 18 patients, 7 patients underwent gross-total resection of the tumor and 7 patients underwent planned near-total resection of the tumor, leaving the cavernous sinus lesion. Subtotal resection was performed in 4 patients with recurrent tumors. There was no postoperative CSF leak requiring reconstruction surgery. Fourteen of 18 patients (77.8%) had preoperative proptosis on the ipsilateral side, and all 14 patients had improvement in exophthalmos; the mean proptosis reduced from 5.7 ± 2.7 mm to 1.5 ± 1.4 mm. However, some residual proptosis was evident in 9 of the 14 (64%). Ten of 18 patients (55.6%) had preoperative optic neuropathy, and 6 of them (60.0%) had improvement; the median best-corrected visual acuity improved from 20/100 to 20/40. Thirteen of 18 patients showed mild ptosis at an immediate postoperative examination, all of whom had a spontaneous and complete recovery of their ptosis during the follow-up period. Three of 7 patients showed improvement in extraocular motility after surgery. CONCLUSIONS: Endoscopic TOA can be considered as an option in the management of cranioorbital tumors involving complex anatomical areas, with acceptable sequelae and morbidity.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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