Clinical and ophthalmological outcome of endoscopic transorbital surgery for cranioorbital tumors

Abstract

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.

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

“…Among tumors, with 67 (65.6%) presented cases, meningioma was the most common pathology followed by trigeminal schwannomas (9.8%). In the 102 tumor cases presented, 50 (49.0%) gross-total resections, 9 (8.8%) near-total resections, 30 (29.4%) sub-total resections, and 6 (5.9%) partial-resections were reported [12,15,16,27,29,31,32,34,53,58]. In 7 (6.9%) patients, biopsies were obtained through TEAs [27,28].…”

“…However, by nature, they also have risks of complications. A total of 60 complications were reported in 193 cases presented (Tables 3 and 4) [3,8,12,15,16,28,29,31,34,53,58]. The majority of the complications reported were transient.…”

“…TEAs refer to a group of surgical corridors that reach or pass through the orbit without removing any part of the bony orbital rim or adjacent structures [3,46,47]. These approaches may be indicated for the treatment of pathologies located within or adjacent to the orbit [3,31,36,43,47]. They may also be…”

“…When the defect is extended beyond the limits of the orbit (e.g., frontal sinus, cribriform plate, planum sphenoidale, lateral recess of the sphenoid), watertight closure should be achieved following the principles of transnasal endoscopic SB reconstruction [3,41,47,48,58]. Various materials such as autologous grafts (e.g., fascia lata, temporalis fascia, iliotibial tract, abdominal fat, septal mucoperichondrium) or synthetic materials (e.g., TachoSil®, AlloDerm®, DuraGen®) have been used either alone or in combination [8,12,14,16,28,29,31,32,34,38,40,41,43,48,53,58]. In the majority of the studies, a multilayer reconstruction was conducted.…”

“…In the majority of the studies, a multilayer reconstruction was conducted. A total of 74 patients required dural reconstruction, and postoperative CSF leak was reported in 3 (4.1%) [8,12,15,16,28,29,31,32,34,40,41,48,53,58]. Even after the reconstruction of large defects, the risk of CSF leak appears to be low as the orbital contents keep the reconstruction in place and tight [1,12,14,46,48,56].…”