April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Management of Orbitocranial Lesions- Indications for Neurosurgical Approaches
Author Affiliations & Notes
  • A. M. Mansury
    Ophthalmology, Jules Stein-UCLA, Los Angeles, California
  • H. Lew
    Ophthalmology, Jules Stein-UCLA, Los Angeles, California
  • R. A. Goldberg
    Ophthalmology, Jules Stein-UCLA, Los Angeles, California
  • Footnotes
    Commercial Relationships  A.M. Mansury, None; H. Lew, None; R.A. Goldberg, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 5733. doi:
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      A. M. Mansury, H. Lew, R. A. Goldberg; Management of Orbitocranial Lesions- Indications for Neurosurgical Approaches. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5733.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To review the clinical findings and results in a series of surgically treated orbitocranial lesions.

Methods: : Data from all orbitocranial cases involving dura or extending into the anterior or middle cranial fossa undergoing surgeries at the Jules Stein Eye Institute, Los Angeles, California, over a period of 15 years were collected and analyzed. Data included visual acuity, exophthalmometry measurements, intraocular pressure, complete slitlamp examination results, ocular ductions, and new-onset primary diplopia. Main Outome Measures: Patient perception of pain and ocular discomfort, proptosis visual acuity, intraocular pressure, postoperative complications, new-onset primary diplopia and recurrence.

Results: : Combined orbital-neurosurgical approach was performed in twelve cases. Deep orbital approaches were done for thirty-eight cases; cavernous hemangioma(n=11), meningioma(n=8), schwanoma(n=4), lacrimal gland tumor(n=2), dermoid cyst(n=2), glioma(n=2), neurofibroma(n=2), osteoma(n=1), solitary fibrous tumor(n=1), hemangiopericytoma(n=1), varix(n=1), lymphoma(n=1), fibrous dysplasia (n=1), foreign body(n=1). Postoperatively, patients developed transient ptosis, numbness, diplopia. But only two (5.3%) patient underwent eye muscle surgery 3.5 years after surgery. No patients developed transient worsening of their visual acuity and visual field. Visual acuity improved after surgery in nine cases. Exophthalmos decreased by a mean +/- SD of 2.1 +/- 2.5 mm (P<.001). Two cases of meningioma recurred mean 3.5 years after surgery and they received radiation treatment. No complications were associated with orbitotomy.

Conclusions: : Deep orbital approach is indicated for benign deep apical tumors that are lateral or inferolateral to the optic nerve, uninflammed dermoid cysts, slowly growing solid benign tumor and non-curable tumor debulking. This less invasive approach is more familiar to ophthalmologist and reduces post operative recovery time and serious complications while providing a relatively wide surgical field.

Keywords: tumors • orbit 

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