Surgical approaches to the orbit

Indications and techniques

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  • 1 Departments of Neurosurgery, Allegheny General Hospital and University of Pittsburgh School of Medicine, and Departments of Ophthalmology and Neurology, Eye and Ear Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
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✓ The authors review their experience with over 300 patients with orbital tumors, and summarize their surgical techniques and indications for each surgical approach. A fronto-orbital approach is described which is used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral micro-orbitotomy is used for tumors located in the superior, temporal, or inferior compartment of the orbit and those in the lateral apex. A medial microsurgical approach is used for tumors located medial to the optic nerve but not deep in the apex. By thus approaching tumors directly, optimal exposure is obtained and functional deficits are minimized. The pertinent surgical anatomy is illustrated and the technique of fine-needle aspiration biopsy is discussed.

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Contributor Notes

Address for Dr. Kennerdell: Department of Ophthalmology, Eye and Ear Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address reprint requests to: Joseph C. Maroon, M.D., Department of Neurosurgery, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, Pennsylvania 15212.
  • 1.

    Alper MG: Management of primary optic nerve meningiomas. Current status — therapy in controversy. J Clin Neuro-ophthalmol 1:101117, 1981 Alper MG: Management of primary optic nerve meningiomas. Current status — therapy in controversy. J Clin Neuro-ophthalmol 1:101–117, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Berke RN: A modified Krönlein operation. Trans Am Ophthalmol Soc 51:193231, 1953 Berke RN: A modified Krönlein operation. Trans Am Ophthalmol Soc 51:193–231, 1953

    • Search Google Scholar
    • Export Citation
  • 3.

    Brihaye J: Neurosurgical approaches to orbital tumours, in Krayenbühl H (ed): Advances and Technical Standards in Neurosurgery. Wien/New York: Springer-Verlag, 1976, Vol 3, pp 103121 Brihaye J: Neurosurgical approaches to orbital tumours, in Krayenbühl H (ed): Advances and Technical Standards in Neurosurgery. Wien/New York: Springer-Verlag, 1976, Vol 3, pp 103–121

    • Search Google Scholar
    • Export Citation
  • 4.

    Char DH, & Norman D: The use of computed tomography and ultrasonography in the evaluation of orbital masses. Surv Ophthalmol 27:4963, 1982 Char DH, Norman D: The use of computed tomography and ultrasonography in the evaluation of orbital masses. Surv Ophthalmol 27:49–63, 1982

    • Search Google Scholar
    • Export Citation
  • 5.

    Dandy WE: Orbital Tumors. Results Following the Transcranial Operative Attack. New York: Oskar Piest, 1941, pp 161164 Dandy WE: Orbital Tumors. Results Following the Transcranial Operative Attack. New York: Oskar Piest, 1941, pp 161–164

    • Search Google Scholar
    • Export Citation
  • 6.

    Frazier CH: An approach to the hypophysis through the anterior cranial fossa. Ann Surg 57:145150, 1913 Frazier CH: An approach to the hypophysis through the anterior cranial fossa. Ann Surg 57:145–150, 1913

    • Search Google Scholar
    • Export Citation
  • 7.

    Galbraith JEK, & Sullivan JH: Decompression of the perioptic meninges for relief of papilledema. Am J Ophthalmol 76:687692, 1973 Galbraith JEK, Sullivan JH: Decompression of the perioptic meninges for relief of papilledema. Am J Ophthalmol 76:687–692, 1973

    • Search Google Scholar
    • Export Citation
  • 8.

    Hayreh SS: Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol 53:721748, 1969 Hayreh SS: Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol 53:721–748, 1969

    • Search Google Scholar
    • Export Citation
  • 9.

    Housepian EM: Intraorbital tumors, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques. New York: Grune & Stratton, 1982, Vol 1, pp 227244 Housepian EM: Intraorbital tumors, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques. New York: Grune & Stratton, 1982, Vol 1, pp 227–244

    • Search Google Scholar
    • Export Citation
  • 10.

    Housepian EM, , Trokel SL, & Jakobiec FO, et al: Tumors of the orbit, in Youmans JR (ed): Neurological Surgery, ed 2. Philadelphia: WB Saunders, 1982, Vol 5, pp 30243064 Housepian EM, Trokel SL, Jakobiec FO, et al: Tumors of the orbit, in Youmans JR (ed): Neurological Surgery, ed 2. Philadelphia: WB Saunders, 1982, Vol 5, pp 3024–3064

    • Search Google Scholar
    • Export Citation
  • 11.

    Jane JA, , Park TS, & Pobereskin LH, et al: The supraorbital approach: technical note. Neurosurgery 11:537542, 1982 Jane JA, Park TS, Pobereskin LH, et al: The supraorbital approach: technical note. Neurosurgery 11:537–542, 1982

    • Search Google Scholar
    • Export Citation
  • 12.

    Kennerdell JS, , Dubois PJ, & Dekker A, et al: CT-guided fine needle aspiration biopsy of orbital optic nerve tumors. Ophthalmology 87:491496, 1980 Kennerdell JS, Dubois PJ, Dekker A, et al: CT-guided fine needle aspiration biopsy of orbital optic nerve tumors. Ophthalmology 87:491–496, 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    Kennerdell JS, & Ghoshhajra K: Computed tomographic scanning of orbital tumors. Int Ophthalmol Clin 22 (4):99131, 1982 Kennerdell JS, Ghoshhajra K: Computed tomographic scanning of orbital tumors. Int Ophthalmol Clin 22(4):99–131, 1982

    • Search Google Scholar
    • Export Citation
  • 14.

    Kennerdell JS, & Maroon JC: Microsurgical approach to intraorbital tumors. Technique and instrumentation. Arch Ophthalmol 94:13331336, 1976 Kennerdell JS, Maroon JC: Microsurgical approach to intraorbital tumors. Technique and instrumentation. Arch Ophthalmol 94:1333–1336, 1976

    • Search Google Scholar
    • Export Citation
  • 15.

    Krönlein RU: Zur Pathologie and operativen Behandlung der Dermoidcysten der Orbita. Beitr Klin Chir 4:149163, 1889 Krönlein RU: Zur Pathologie and operativen Behandlung der Dermoidcysten der Orbita. Beitr Klin Chir 4:149–163, 1889

    • Search Google Scholar
    • Export Citation
  • 16.

    MacCarty CS, & Brown DN: Orbital tumors in children. Clin Neurosurg 11:7693, 1964 MacCarty CS, Brown DN: Orbital tumors in children. Clin Neurosurg 11:76–93, 1964

    • Search Google Scholar
    • Export Citation
  • 17.

    Mark LE, , Kennerdell JS, & Maroon JC, et al: Microsurgical removal of a primary intraorbital meningioma. Am J Ophthalmol 86:704709, 1978 Mark LE, Kennerdell JS, Maroon JC, et al: Microsurgical removal of a primary intraorbital meningioma. Am J Ophthalmol 86:704–709, 1978

    • Search Google Scholar
    • Export Citation
  • 18.

    Maroon JC, & Kennerdell JS: Lateral microsurgical approach to intraorbital tumors. J Neurosurg 44:556561, 1976 Maroon JC, Kennerdell JS: Lateral microsurgical approach to intraorbital tumors. J Neurosurg 44:556–561, 1976

    • Search Google Scholar
    • Export Citation
  • 19.

    Mill NR: Anatomy and physiology of the optic nerve, in Walsh FB, & Hoyt WF (eds): Clinical Neuro-Ophthalmology, ed 4. Baltimore: Williams & Wilkins, 1982, Vol 1, pp 4159 Mill NR: Anatomy and physiology of the optic nerve, in Walsh FB, Hoyt WF (eds): Clinical Neuro-Ophthalmology, ed 4. Baltimore: Williams & Wilkins, 1982, Vol 1, pp 41–59

    • Search Google Scholar
    • Export Citation
  • 20.

    Naffziger HC: Progressive exophthalmos following thyroidectomy; its pathology and treatment. Ann Surg 94:582586, 1931 Naffziger HC: Progressive exophthalmos following thyroidectomy; its pathology and treatment. Ann Surg 94:582–586, 1931

    • Search Google Scholar
    • Export Citation
  • 21.

    Pertuiset B, , Morax PV, & Aron D, et al: La voie frontotemporale extra-durale: sa place dans l'abord des tumeurs de l'orbite (d'après 18 observations). Ann Oculist 196:917933, 1963 Pertuiset B, Morax PV, Aron D, et al: La voie frontotemporale extra-durale: sa place dans l'abord des tumeurs de l'orbite (d'après 18 observations). Ann Oculist 196:917–933, 1963

    • Search Google Scholar
    • Export Citation
  • 22.

    Peyster RG, , Hoover ED, & Hershey BL, et al: High resolution CT of lesions of the optic nerve. AJNR 4:169174, 1983 Peyster RG, Hoover ED, Hershey BL, et al: High resolution CT of lesions of the optic nerve. AJNR 4:169–174, 1983

    • Search Google Scholar
    • Export Citation
  • 23.

    Smith JL, , Vuksanovic MM, & Yates BM, et al: Radiation therapy for primary optic nerve meningiomas. J Clin Neuro Ophthalmol 1:8589, 1981 Smith JL, Vuksanovic MM, Yates BM, et al: Radiation therapy for primary optic nerve meningiomas. J Clin Neuro Ophthalmol 1:85–89, 1981

    • Search Google Scholar
    • Export Citation
  • 24.

    Trokel SL, & Hilal SK: Submillimeter resolution CT scanning of orbital diseases. Ophthalmology 87:412417, 1980 Trokel SL, Hilal SK: Submillimeter resolution CT scanning of orbital diseases. Ophthalmology 87:412–417, 1980

    • Search Google Scholar
    • Export Citation
  • 25.

    Wright JE, , Call NB, & Liaricos S: Primary optic nerve meningioma. Br J Ophthalmol 64:553558, 1980 Wright JE, Call NB, Liaricos S: Primary optic nerve meningioma. Br J Ophthalmol 64:553–558, 1980

    • Search Google Scholar
    • Export Citation

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