Surgical treatment of tumors of the orbit and cranio-orbital region
Keywords:orbit, cranio-orbital region, tumor, lateral orbitotomy, transcranial orbitotomy
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.
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