ORIGINAL ARTICLES   

Journal of Neurosurgical Sciences 1998 December;42(4):185-8

Copyright © 1998 EDIZIONI MINERVA MEDICA

lingua: Inglese

Removal of tumours of the orbital apex via a postero-lateral orbitotomy

Carta F., Siccardi D., Cossu M., Viola C., Maiello M.

Department of Neurosurgery, University of Genoa Medical School, Genoa, Italy

Background. The sur­gi­cal man­age­ment of ­pure api­cal ­tumours of ­the ­orbit ­may be prob­le­mat­ic ­with tra­di­tion­al approach­es. A pos­te­ro-lat­er­al ­approach, spe­cif­i­cal­ly ­designed ­for api­cal ­growths, pro­vides a ­more favour­able ­angle of ­vision ­through a rel­a­tive­ly ­small ­bone open­ing.
Methods. A ­series of 103 con­sec­u­tive cas­es of intra­or­bi­tal ­tumours, oper­at­ed on in a com­mu­nity-­based insti­tu­tion, ­was ret­ro­spec­tive­ly ­reviewed. Out of ­this ­series, 8 ­patients, har­bour­ing ­lesions locat­ed in ­the pos­te­ri­or intra­co­nal ­space, under­went a pos­te­ro-lat­er­al orbi­tot­o­my. This ­approach, ­through a ­small open­ing on ­the orbi­tal ­and tem­po­ral por­tions of ­the great­er ­wing of ­the sphe­noid, ­with ­the less­er sphe­noid­al ­wing, ­the orbi­tal ­plate of ­the fron­tal ­bone, ­the lat­er­al ­rim of ­the ­orbit ­being main­tained ­intact, ­allowed ade­quate expo­sure of ­the orbi­tal ­apex ­and suc­cess­ful extir­pa­tion of ­the ­tumours. In ­four ­patients ­the his­to­log­i­cal exam­ina­tion dis­closed a caver­no­ma; ­the oth­er ­patients ­had, respec­tive­ly, a der­moid ­cyst, a lym­pho­ma, a heman­gio­per­i­cy­to­ma ­and a met­a­stat­ic mel­a­no­ma.
Results. No recur­renc­es ­were ­observed in a fol­low-up peri­od rang­ing ­from 1 to 7 ­years post­op­er­a­tive­ly (­the ­patient ­with mel­a­no­ma ­died 16 ­months ­after oper­a­tion ­for system­ic com­pli­ca­tions of ­her ill­ness). One ­patient ­showed tran­sient weak­ness of lat­er­al rec­tus mus­cle ­due to sur­gi­cal manip­u­la­tion, ­which sub­sid­ed in ­few ­months.
Conclusions. The pos­te­ro-lat­er­al orbi­tot­o­my rep­re­sents a reli­able alter­na­tive to oth­er tra­di­tion­al sur­gi­cal approach­es ­when deal­ing ­with ­tumours of ­the orbi­tal ­apex, pro­vid­ing excel­lent expo­sure of ­this ­region ­with a ­low ­rate of oper­a­tive mor­bid­ity.