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Julie Linden, Pete Batra, Kamel Itani, Ronald Mancini; Retrospective review to evaluate the collaborative management and multi-disciplinary approach to skull-base pathology at a Tertiary medical center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2788.
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To evaluate the combined surgical management of skull-base pathology to better describe an optimized surgical approach to combined endoscopic and orbital surgeries at a tertiary medical center.
A retrospective analysis was performed on combined sino-orbital surgeries, performed by an oculoplastic surgeon and otorhinolaryngologist, during a two-year period. The typical pathology managed, surgical procedure, complication rates, recurrences, clinical outcomes, mean follow-up and long-term orbital sequelae were analyzed.
Twenty-five patients with a mean age of 50.6 (range 13-66, M: F ratio of 3:1) and mean follow-up time of 8.7 months were analyzed. The pathology managed included 13 malignancies (50%), 7 benign cases (30%), and 5 infections (20%) with 10 cases involving the skull-base. The most common surgical approach used was an image-guided endoscopic sinus resection with anterior orbitotomy in 9 cases (36%). Other approaches included 7 endoscopic sinus resections with dacryocystorhinsotomy (28%), 5 combined open and endoscopic sinus resections (20%), and a craniofacial approach in conjunction with neurosurgery in 2 cases (8%). No intra-operative complications occurred. Two cases of Mucor invasive rhinosinusitis underwent 3 combined debridement surgeries, with one ending in death remotely in the post-operative period. Long term visual outcomes, excluding one eye with no light perception pre-operatively, included 2 exenterations, 2 cases of persistent diplopia, 2 cases of radiation induced retinopathy, and 1 case with ophthalmoplegia.
Current literature reporting common pathology encountered and surgical approach to combined endoscopic and orbital surgeries is limited. Several advantages result from a combined multi-disciplinary surgical approach to advanced orbital and sinonasal pathology. Endoscopic and image-guided technology combined with an anterior orbitotomy, provides a less invasive surgical approach to skull-base pathology, minimizes complications, allows a safer dissection to protect key orbital structures, maximize preservation of tissue, while allowing good visual outcomes with decreased morbidity and mortality.
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