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Joseph C. Maroon, John S. Kennerdell, Danko V. Vidovich, Adnan Abla and Linda Sternau

T he vagaries of diagnosis and treatment of spheno-orbital meningiomas have taxed the ingenuity and surgical expertise of the most skilled neurosurgeons including Cushing, 15 Olivecrona, 40 MacCarty, 32 Guiot, Derome, and colleagues, 16, 17, 23, 24 Basso, et al. , 9 Castellano, et al. , 12 Stern, 46 Dolenc, 18, 19 Jane and colleagues, 27, 28 Al-Mefty and colleagues, 2–7 and others. Their observations and contributions, however, are sometimes overlooked by neurosurgeons and ophthalmologists confronted by these unusual tumors, which are located in

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Surgical approaches to the orbit

Indications and techniques

Joseph C. Maroon and John S. Kennerdell

I n 1976, we reported the results in our first seven patients with intraorbital tumors removed through the lateral microsurgical approach. 18 Since then, we have treated over 300 additional patients with orbital tumors, pseudotumors, and dysthyroid orbital disease ( Table 1 ). In all cases, a combined neurosurgical/neuroophthalmological diagnostic and therapeutic approach was used. Due to technical innovations in high-resolution computerized tomography (CT) scanning 4, 13, 22, 24 and diagnostic ultrasound, 4 the introduction of lasers and ultrasonic

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Andrew H. Kaye, Joseph F. Hahn, Atanase Craciun, Maurice Hanson, A. Jan Berlin and Raymond R. Tubbs

O rbital pseudotumors are inflammatory lesions of unknown origin within the orbit, which initially simulate a true neoplasm. Although Birch-Hirschfeld, 2 who introduced the term, included all non-neoplastic disorders, ophthalmologists generally limit the term to those lesions that are of an idiopathic inflammatory nature. 3, 4, 16 The lesion usually presents as an orbital tumor. Involvement of the lacrimal gland and muscle cone is common, but extension into the periosteum is rare. 11 Although involvement of the paranasal sinus has been infrequently noted

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Akio Asai, Masao Matsutani, Takeshi Kohno, Takamitsu Fujimaki, Hideki Tanaka, Kenji Kawaguchi, Morio Koike and Kintomo Takakura

is extremely rare. A case of isolated subarachnoidal and orbital histiocytosis without any other lymph node involvement is presented. S-100 protein staining was very useful in confirming the diagnosis of SHML in the orbital lesion which showed atypical histological findings. Case Report This 39-year-old man came to the hospital with marked proptosis of the left eye. One year before admission, he had first noted slight proptosis which gradually increased in severity. There were no other symptoms. Examination Examination revealed marked left

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Joseph C. Maroon and John S. Kennerdell

I n 1948, Naffziger 15 published his observations on the neurosurgical aspects of the management of exophthalmos and stated, “Orbital conditions require the attention of the ophthalmologist, and study by him in conjunction with the pathologist, radiologist and neurological surgeon should yield valuable dividends and improved treatment.” For the last 5 years, we have followed Naffziger's admonition and have jointly evaluated all patients with mass lesions in and about the orbit. One of the most challenging conditions encountered has been the extreme

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Yoshihiro Natori and Albert L. Rhoton Jr.

T he earliest reports of surgery for orbital lesions involved approaches directed through the lateral wall of the orbit. 15, 18, 19, 21 The first report of a transcranial approach to the orbit was published in 1922 by Dandy. 5 Since then, various approaches to the orbit have been developed. 1, 8, 11, 13, 17, 22 Most authors have not focused on the exposure of specific structures within the orbit, such as the optic nerve and the deep orbital apex area, 2 but have mainly presented details of the operative route used to reach the orbit. This publication

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Johan M. Kros, Herbert van den Berge, Hervé L. J. Tanghe and Stef L. M. Bakker

G lial neoplasms only rarely invade the subarachnoid space or metastasize via the CSF. 6, 18, 23 Moreover, it is highly unusual for glial tumor cells to infiltrate the dura and subsequently invade adjacent structures. 22 In this case report we describe a GBM located in the right temporal lobe, with extensive subarachnoid spread and invasion of the left orbit. The literature on extracerebral dissemination of gliomas is also briefly discussed. Case Report History This 46-year-old man was admitted to our Department of Neurology after a single generalized

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Franco Demonte, Peyman Tabrizi, Scott A. Culpepper, Dima Suki, Charles N. S. Soparkar and James R. Patrinely

D uring resection of anterior and anterolateral skull base tumors it is not uncommon for the orbit to be entered. Oncologically sound removal of these tumors, the majority of which are malignant, typically requires resection of one or more of the osseous orbital walls. This may be necessary because of direct orbital involvement by the tumor leading to erosion of the orbital bones, or it may be planned to include a noninvolved margin of resection. Controversy exists regarding the timing, need for, and extent of orbital reconstruction after these partial orbital

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John A. Persing, John A. Jane, T. S. Park, Milton T. Edgerton and Johnny B. Delashaw

S kulls deformed by metopic, unilateral, or bilateral coronal synostosis result in diminished projection of the supralateral orbital rim. 1, 5–13 In addition, individuals with coronal and to a lesser extent metopic synostosis have reduced anteroposterior projection of the zygoma ( Fig. 1 ). Although many methods have been described to correct the orbital rim abnormalities, the lateral canthal advancement technique is presently the most widely practiced. 7 There are two problems with this technique, however. First, with this procedure, the advancement of the

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Andrei Koerbel, Veralucia R. Ferreira and André Kiss

T he orbit is a small compartment containing very delicate structures that are essential for the function of vision. Approaches to treat orbital diseases should provide a good exposure of anatomical structures and allow preservation of their function, such as ocular motility and visual acuity. Additionally, in the cases of exophthalmos or ocular deviation, surgery should maintain or improve a patient's physiognomical appearance. Several approaches to the intraorbital space have been described in the literature. 3 , 5 , 8 , 12 Most require bone removal