Cranio-Orbital Tumors; Clinical Results and Surgical Approach

Abstract

O rbit is an anatomical structure measuring approximately 40 mm in height, 45 mm in depth and up to 30 ml in volume and confined with cranial, facial and nasal. Bones Cranio-orbital tumors can be divided schematically into three groups. Primary lesions originate from structures within the orbit. Secondary lesions are intracranial tumors and paranasal sinuses that extend into the orbit from surrounding structures. The third group is metastatic tumors. [1] Orbital tumors can be divided into three categories according to their anotomic location: 1) Intraconal (within the cone of extraocular muscles), 2) extraconal, and 3) intracanalicular (within the optic canal) tumors. This classification of localization is made according to the cone shape starting from the posterior of the eye globe made by extraocular muscles and ending in the Zinn ring. [2] In terms of surgical approach to orbital tumors, three surgical approaches can be applied: 1) Transorbital approaches are generally used for tumors in the anterior part of the orbit. [3] 2) Extraorbital-transcranial approaches are mostly used for lesions located on the posterior part of the orbit, lateral and superior optic nerve. [4, 5] 3) Endonasal transcranial approaches can be used for tumors located in the medial part of the orbita. [6, 7] The extraorbital-transcranial approaches are mainly divided into lateral and anterior Objectives: In this study, we aimed to share the surgical approaches and clinical experiences of cranio-orbital tumors, which are surgically difficult anatomies. Methods: A total of 22 orbital tumors with extraorbital-transcranial pathology between January 2004 and December 2017 were retrospectively reviewed. Information was obtained from hospital, operation and outpatient records for this study. Preoperative demographic data, ophthalmologic examination findings, clinical and radiological findings were recorded. All patients had cranial magnetic resonance and cranial computerised tomography examinations at this time. The location of the tumor, its size and its relation to neighboring structures were recorded in the light of these examinations. Results: The lateral approach was performed in 12 cases. The lateral approach was performed with frontotemporal craniotomy. Because of the lateral inferior location of the tumor in three of 12 cases, zygoma osteotomy was added to classical osteotomy. In 10 cases, the anterior approach was applied and the frontal craniotomy was found sufficient in seven cases. In three cases subfrontal craniotomy was added to classical craniotomy. Conclusion: The findings obtained in this study suggest that high resection rates can be achieved with appropriate surgical intervention in orbital tumors requiring a transcranial surgical approach. The most important factor in surgical planning is the location of the tumor. The size of the tumor and the expectation of the percentage of surgical removal are the other important factors. In our series, it has reached high excision ratio in most cases with low complication rate, good visu...

Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients

“…Trauma, chronic infections, and malformation syndromes are the main causes of defects in the cranio-orbital region, with benign and malignant tumors representing the most frequent type of etiology in our series. Orbito-cranial neoplasms can be of primary origin, and secondary tumors and metastasis tumors, being primary orbit lesions, are the most frequently described in the literature [4]. In our case series, the majority of cases showed the secondary origin of tumors arising from surrounding anatomical regions.…”

“…For benign or smaller tumors located in the midline of the anterior skull base, a transnasal endoscopic approach can be a viable option. However, for major benign lesions or malignant tumors, as presented in our study, alternative surgical approaches should be chosen, including the coronal approach, the lateral approach, the anterolateral approach, or a combination of these approaches [4,7].…”