Surgical treatment of tumors of the orbit and cranio-orbital region

Authors

  • M.E. Polishchuk Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • M.S. Gudym State Institution “Scientific Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sceinces of Ukraine”, Kyiv, Ukraine
  • D.V. Shchehlov State Institution “Scientific Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sceinces of Ukraine”, Kyiv, Ukraine
  • O.M. Goncharuk Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • A.A. Oblyvach MNPE “Kyiv City Clinical Emergency Hospital”, Kyiv, Ukraine
  • S.A. Usatov Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • M.B. Vyval State Institution “Scientific Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sceinces of Ukraine”, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2309-8147.9.1.2021.229523

Keywords:

orbit, cranio-orbital region, tumor, lateral orbitoto­my, transcranial orbitotomy

Abstract

Background. Surgical treatment of space-occupying orbital masses and cranio-orbital tumors is relevant due to the features of the diagnosis and surgical stage of treatment because of the dense arrangement of neurovascular and muscular structures in a small orbital space. The purpose was to determine the features of the surgical treatment of orbital and cranio-orbital tumors. Mate­rials and methods. A retrospective analysis of 102 patients (76 women, 26 men) with orbital and cranio-orbital tumors who were treated at the Department of Neurosurgery 2 at Kyiv City Clinical Emergency Hospital from 2000 to 2016 was carried out. Results. Eighty-six (84.3 %) patients had benign tumors, 16 (15.7 %) — malignant. Pterional craniotomy with orbitotomy was performed in 72 (70.6 %) cases, lateral orbital approach was used in 20 (19.6 %) patients, and anterior orbitotomy — in 10 (9.8 %). Total tumor resection was achieved in 71 (69.6 %) cases. After the removal of tumors located in the anterior 2/3 of the orbit and orbital apex, a satisfactory and good result was achieved in 93.9 and 92.4 %, respectively. The worst results were obtained after surgical treatment of tumors located in the posterior third of the orbit, which were intra- and extraconal, unsatisfactory results was observed in 37.5 % of cases in each group (II and III). In the early postoperative period, 18 (17.6 %) patients had complications, the most frequent were: visual impairment — 8.8 %, oculomotor di­sorders — 8.8 %, and ptosis — 5.9 %. However, in 6 patients they regressed by the time of discharge. The risk of complications was higher after the removal of intraconal tumors of the posterior third of the orbit (odds ratio 5.71 (95% confidence interval 1.28–25.55), p = 0.012), and did not depend on histological structure. Conclusions. The choice of a surgical approach for removing orbital and cranio-orbital tumors depends on the relation of the tumor to the plane of optic nerve, muscular cone, optic canal, superior orbital fissure. The results of the treatment for orbital and cranio-orbital tumors depended primarily on the location and spread of the process at the time of surgery. Worsening of symptoms after surgical treatment was found mainly in patients with tumors of the posterior third of the orbit.

References

Бровкина А.Ф. Новообразования орбиты. Москва: Медицина, 1974. 256 с.

Терентьева Л.С. Диагностика и хирургическое лечение новообразований орбиты. Офтальмол. журн. 2000. № 3. С. 4-8.

Трош Р.М. Диагностика и хирургическое лечение кранио­орбитальных менингиом [диссертация]. Киев: Киевский НИИ нейрохирургии МЗ УССР, 1984. 41 с.

Dandy W.E. Prechiasmal intracranial tumors of the optic nerves. Am. J. Ophthalmol. 1922. 5(3). 169-188. https://doi.org/10.1016/S0002-9394(22)90261-2

Margalit N., Ezer H., Fliss D.М., Naftaliev E., Nossek E., Kesler A. Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients. Neurosurg Focus. 2007. 23(5). E11. doi: 10.3171/FOC-07/11/E11.

Pai S.В., Nagarjun M.N. A neurosurgical perspective to approaches to the orbit: A cadaveric study. Neurol. India [serial online]. 2017. 65. 1094-101. Available from: http://www.neurologyindia.com/text.asp?2017/65/5/1094/214068

Патент 33359 А України, МПК 6А 61В 17/00. Спосіб доступу до пухлин орбіти. Петренко Н.Е., Поліщук Н.Є., Сергієнко М.М., заявл. № 99020844 від 15.02.1999 р., опубл. 15.02.2001 р. Бюл. № 1.

Paluzzi A., Gardner P.А., Fernandez-Miranda J.С. et al. Round-the-Clock Surgical Access to the Orbit. J. Neurol. Surg. B. Skull Base. 2015 Feb. 76(1). 12-24. doi: 10.1055/s-0033-1360580. PMID: 25685644. Central PMCID: PMC4318736.

Зозуля Ю.А., Трош Р.М. Кранио-орбитальные опухоли. Киев: Здоров’я, 1988. 152 с.

Cockerham K., Bejjani G., Kennerdell J., Maroon J. Surgery for orbital tumors. Part 2: transorbital approaches. Neurosurg. Focus. 2001.

Youmans J.R., Winn H.R. Youmans neurological surgery. Philadelphia, PA: Saunders, 2011.

Закондырин Д.Е. Хирургическое лечение новообразований краниоорбитальной области и глазницы [диссертация]. Санкт-Петербург: ГУ «Научно-исследовательский институт нейрохирургии им. акад. Н.Н. Бурденко» РАМН, 2010. 210 с.

Hejazi N. Intraorbital lymphomas: neurosurgical experiences and management strategies. Neurosurg. Rev. 2006 Apr. 29(2). 123-9. PMID: 16397817. doi: 10.1007/s10143-005-0008-2.

Published

2021-04-29

Issue

Section

Ophthalmosurgery