Ophthalmological outcome after orbital entry during anterior and anterolateral skull base surgery

Restricted access

Object. Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of reconstruction after this procedure. The authors studied this factor in a series of patients.

Methods. The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbital outcome was strongly associated with resection of the orbital floor and resection of two thirds or more of two or more orbital walls, but not with the presence or absence of orbital reconstruction. The latter finding, however, is likely a function of selection bias.

Conclusions. In most patients elaborate orbital reconstruction is not necessary after partial excision of the orbital bones. Isolated medial and lateral orbital wall defects, or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple-wall resection, primary reconstruction is recommended.

Article Information

Address reprint requests to: Franco DeMonte, M.D., F.R.C.S.(C), Department of Neurosurgery, Box 442, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. email: fdemonte@mdanderson.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Upper: Preoperative coronal, T1-weighted, postcontrast, fat-suppressed magnetic resonance images demonstrating an ethmoidal adenocarcinoma that was adherent to the periorbital membrane, necessitating resection of the right medial orbital wall, the medial part of the orbital floor, and the medial periorbital membrane. Lower: Postoperative coronal, T1-weighted, postcontrast, fat-suppressed magnetic resonance images demonstrating the medial herniation of orbital fat. This resulted in the entrapment of the orbital contents and an esotropia.

  • View in gallery

    Left: Preoperative coronal computerized tomography scan at bone window settings demonstrating a large mass in the maxillary sinus and erosion of the orbital floor. Repeated imaging (not shown) revealed tumor extension into the ethmoidal sinus and infratemporal fossa, necessitating resection of the entire floor and lateral wall of the orbit and more than two thirds of the medial wall. Right: Photograph showing that, despite immediate reconstruction of the orbital floor with a titanium reconstruction plate and local soft tissue, progressive enophthalmos developed, which required surgical revision.

  • View in gallery

    Artist's representation of the bones of the cranium and face that contribute to the formation of each of the walls of the orbit.

References

  • 1.

    Adkins WY Jr: Maxillectomy with preservation of orbital function. Surg Forum 27:5485501976Adkins WY Jr: Maxillectomy with preservation of orbital function. Surg Forum 27:548–550 1976

  • 2.

    Bumpous JJanecka IP: Transorbital approaches to the cranial base. Clin Plast Surg 22:4614811995Bumpous J Janecka IP: Transorbital approaches to the cranial base. Clin Plast Surg 22:461–481 1995

  • 3.

    Catalano PJSen C: Management of anterior ethmoid and frontal sinus tumors. Otolaryngol Clin North Am 28:115711741995Catalano PJ Sen C: Management of anterior ethmoid and frontal sinus tumors. Otolaryngol Clin North Am 28:1157–1174 1995

  • 4.

    Evans BTNeil-Dwyer GLang D: Reconstruction following extensive removal of meningioma from around the orbit. Br J Neurosurg 8:1471551994Evans BT Neil-Dwyer G Lang D: Reconstruction following extensive removal of meningioma from around the orbit. Br J Neurosurg 8:147–155 1994

  • 5.

    Freije JEGluckman JLVanLoveren Het al: Reconstruction of the anterior skull base after craniofacial resection. Skull Base Surg 2:17211992Freije JE Gluckman JL VanLoveren H et al: Reconstruction of the anterior skull base after craniofacial resection. Skull Base Surg 2:17–21 1992

  • 6.

    Jane JAPark TSPobereskin LHet al: The supraorbital approach: technical note. Neurosurgery 11:5375421982Jane JA Park TS Pobereskin LH et al: The supraorbital approach: technical note. Neurosurgery 11:537–542 1982

  • 7.

    Kang JKLee IWJeun SSet al: Tumors of the orbit. Pitfalls of the surgical approach in 37 children with orbital tumor. Childs Nerv Syst 13:5365411997Kang JK Lee IW Jeun SS et al: Tumors of the orbit. Pitfalls of the surgical approach in 37 children with orbital tumor. Childs Nerv Syst 13:536–541 1997

  • 8.

    Larson DLChrist JEJesse RH: Preservation of the orbital contents in cancer of the maxillary sinus. Arch Otolaryngol 108:3703721982Larson DL Christ JE Jesse RH: Preservation of the orbital contents in cancer of the maxillary sinus. Arch Otolaryngol 108:370–372 1982

  • 9.

    Maroon JC: Comment on Jane JA, Park TS, Pobereskin LH, et al: the supraorbital approach: technical note. Neurosurgery 11:5375421982Maroon JC: Comment on Jane JA Park TS Pobereskin LH et al: the supraorbital approach: technical note. Neurosurgery 11:537–542 1982

  • 10.

    McCary WSLevine PA: Management of the eye in the treatment of sinonasal cancers. Otolarnygol Clin North Am 28:123112381995McCary WS Levine PA: Management of the eye in the treatment of sinonasal cancers. Otolarnygol Clin North Am 28:1231–1238 1995

  • 11.

    Raulo Y: Fronto-orbital reconstruction following resection of benign tumor. Clin Plast Surg 9:5495541982Raulo Y: Fronto-orbital reconstruction following resection of benign tumor. Clin Plast Surg 9:549–554 1982

  • 12.

    Shore JWCarvajal JWestfall CT: Miniplate reconstruction of the lateral orbital rim after orbital decompression for Graves disease. Ophthalmology 99:143314391992Shore JW Carvajal J Westfall CT: Miniplate reconstruction of the lateral orbital rim after orbital decompression for Graves disease. Ophthalmology 99:1433–1439 1992

  • 13.

    Stern SJGoepfert HClayman Get al: Orbital preservation in maxillectomy. Otolaryngol Head Neck Surg 109:1111151993Stern SJ Goepfert H Clayman G et al: Orbital preservation in maxillectomy. Otolaryngol Head Neck Surg 109:111–115 1993

  • 14.

    Trokel SLCooper WC: Symposium: extraocular muscle problem associated with graves' disease. Orbital decompression: effect on motility and globe position. Ophthalmology 86:206420701979Trokel SL Cooper WC: Symposium: extraocular muscle problem associated with graves' disease. Orbital decompression: effect on motility and globe position. Ophthalmology 86:2064–2070 1979

  • 15.

    Wirtschafter JDChu AE: Lateral orbitotomy without removal of the lateral orbital rim. Arch Ophthalmol 106:146314681988Wirtschafter JD Chu AE: Lateral orbitotomy without removal of the lateral orbital rim. Arch Ophthalmol 106:1463–1468 1988

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 74 74 4
Full Text Views 151 151 0
PDF Downloads 82 82 0
EPUB Downloads 0 0 0

PubMed

Google Scholar