Orbital reconstruction for tumor-associated proptosis: quantitative analysis of postoperative orbital volume and final eye position

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OBJECTIVE

Surgical resection of sphenoid wing tumors and intraorbital pathology carries the dual goal of appropriately treating the target pathology as well as correcting proptosis. Residual proptosis following surgery can lead to cosmetic and functional disability. The authors sought to quantitatively assess the effect of orbital volume before and after reconstruction to determine the optimal strategy to achieve proptosis correction.

METHODS

All surgeries involving orbital wall reconstruction for orbital or intracranial pathology that preoperatively resulted in proptosis between 2007 and 2017 were reviewed. Proptosis was measured by the exophthalmos index (EI): the ratio of the distance of the anterior limit of each globe to a line drawn between the anterior limit of the frontal processes of the zygomas, comparing the pathological eye to the normal eye. Postoperative radiographic measurements were taken at least 60 days after surgery to allow surgical swelling to abate. The orbit contralateral to the pathology was used as an internal control for normal anatomical orbital volume. Cases with preoperative EI < 1.10, orbital exenteration, or enucleation were excluded.

RESULTS

Twenty-three patients (16 females and 7 males, with a mean age of 43.6 ± 22.8 years) were treated surgically for tumor-associated proptosis. Nineteen patients harbored meningiomas (11 en-plaque; 8 sphenoid wing), and one patient each harbored an orbital schwannoma, glomangioma, arteriovenous malformation, or cavernous hemangioma. Preoperative EI averaged 1.28 ± 0.10 (range 1.12–1.53). Median time to postoperative imaging was 19 months. Postoperatively, the EI decreased to a mean of 1.07 ± 0.09. Greater increases in size of the reconstructed orbit were positively correlated with greater quantitative reductions in proptosis (p < 0.01). Larger volume of soft tissue pathology was also associated with achieving greater proptosis correction (p < 0.01). Residual exophthalmos (defined as EI > 1.10) was present in 8 patients, while reconstruction in 2 patients resulted in clinically asymptomatic enophthalmos (defined as EI < 0.95). Tumor invasion into the superior orbital fissure sinus was associated with residual proptosis (p = 0.04).

CONCLUSIONS

Proptosis associated with intracranial and orbital pathology represents a surgical challenge. The EI is a reliable and quantitative assessment of proptosis. For orbital reconstruction in cases of superior orbital fissure involvement, surgeons should consider rebuilding the orbit at slightly larger than anatomical volume.

ABBREVIATIONS CS = cavernous sinus; EI = exophthalmos index; SOF = superior orbital fissure.
Article Information

Contributor Notes

Correspondence Carl B. Heilman: Tufts Medical Center, Boston, MA. cheilman@tuftsmedicalcenter.org.INCLUDE WHEN CITING Published online March 8, 2019; DOI: 10.3171/2018.12.JNS181385.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Bowers CASorour MPatel BCCouldwell WT: Outcomes after surgical treatment of meningioma-associated proptosis. J Neurosurg 125:5445502016

  • 2

    Chambless LBMawn LAForbes JAThompson RC: Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: a novel technique. J Craniomaxillofac Surg 40:e28e322012

    • Search Google Scholar
    • Export Citation
  • 3

    DeMonte FTabrizi PCulpepper SASuki DSoparkar CNPatrinely JR: Ophthalmological outcome after orbital entry during anterior and anterolateral skull base surgery. J Neurosurg 97:8518562002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Freeman JLDavern MSOushy SSillau SOrmond DRYoussef AS: Spheno-orbital meningiomas: a 16-year surgical experience. World Neurosurg 99:3693802017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Gonen LNov EShimony NShofty BMargalit N: Sphenoorbital meningioma: surgical series and design of an intraoperative management algorithm. Neurosurg Rev 41:2913012018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Gupta SKaliki SGowrishankar S: Concomitant orbital cavernous haemangioma and schwannoma in a patient. BMJ Case Rep 2017:bcr2016218638 2017

    • Search Google Scholar
    • Export Citation
  • 7

    Maroon JCKennerdell JSVidovich DVAbla ASternau L: Recurrent spheno-orbital meningioma. J Neurosurg 80:2022081994

  • 8

    Oya SSade BLee JH: Sphenoorbital meningioma: surgical technique and outcome. J Neurosurg 114:124112492011

  • 9

    Ringel FCedzich CSchramm J: Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60 (4 Suppl 2):2142222007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Saeed Pvan Furth WRTanck MFreling Nvan der Sprenkel JWStalpers LJ: Surgical treatment of sphenoorbital meningiomas. Br J Ophthalmol 95:99610002011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Sato KMatsumoto YKondo RTominaga T: Intraorbital arteriovenous malformation treated by transarterial embolization: technical case report. Neurosurgery 68 (2 Suppl Operative):3833872011

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Scarone PLeclerq DHéran FRobert G: Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg 111:106910772009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Schick UBleyen JBani AHassler W: Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:2082142006

  • 14

    Shrivastava RKSen CCostantino PDDella Rocca R: Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:4914972005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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