Commentary [Frontozygomatic Approach to Intraorbital Tumors]

Numa reports 12 patients with large intraorbital lesions that became symptomatic with exophthalmos. I agree that a procedure with orbital osteotomy is required for the treatment of these lesions. A few neurosurgeons will attempt to resect these lesions alone, but many will request the presence of an oculoplastic-trained ophthalmologist. Numa shows that resection of these lesions can be difficult. Meningiomas can often be attached to the optic nerve causing transient visual difficulties. Widened exposure of the entire optic nerve can help limit this complication and control the surgeon's desire to obtain complete resection. We have found that debulking in the absence of a good surgical plane between tumor and nerve is sometimes the best option.