Frontozygomatic Approach to Intraorbital Tumors

ABSTRACT

We removed 12 intraorbital tumors (5 schwannomas, 3 meningiomas, 2 cavernomas, 1 pleomorphic adenoma, and 1 neuroblastoma) using the frontozygomatic approach. No patients died. Postoperatively, 1 patient developed transient ptosis, and 3 patients had mild enophthalmos. Two patients with a meningioma developed transient worsening of their visual acuity and visual field. The frontozygomatic approach for surgical treatment of intraorbital tumors provides a wide visual field exposing the entire optic nerve. This approach is indicated for large intraorbital tumors, tumors affecting the optic nerve or orbital apex, intraorbital tumors that have extended into the intracranial cavity, and intracranial tumors that have extended into the orbit. The operative procedure for intraorbital tumor is determined by the location of the lesion and by the direction of its growth. The procedure is applicable to all intraorbital tumors. It reduces discomfort for surgeons while providing a relatively wide surgical field.

KEYWORDS

Intraorbital tumors - frontozygomatic approach - skull base surgery

REFERENCES

• 1 Akiyama H, Kondo T. Therapeutic experience of intraorbital tumor: 31 examples extracerebral mainly on total extirpation by fronto-orbito-zygomatic approach.  No Shinkei Geka. 1997;  25(10) 913-917
• 2 Ciappetta P, Delfini R. Surgical strategies in the treatment of symptomatic osteomas of the orbital walls.  Neurosurgery. 1992;  31 628-635
• 3 Fujitsu K, Kawabata T. Zygomatic approach to the interpedunclar cistern.  J Neurosurg. 1985;  62(3) 340-343
• 4 Fujitsu K, Kawabata T. Orbitocraniobasal approach for anterior communicating artery aneurysms.  Neurosurgery. 1986;  18(3) 367-369
• 5 Fujitsu K. Orbito-zygomatic approach: operative procedure and clinical application.  No Shinkei Geka. 1991;  19 301-308
• 6 Fukushima T, Hirakawa K. Transendothelial skull approach for intraorbital mass and the consequence [Jpn].  Nerve Ophthalmology. 1998;  15 297-304
• 7 Fukushima T, Hirohita T. Surgical approach to the cavernous angioma of the orbit, with special reference to the orbital microsurgical anatomy.  Jpn J Neurosurg. 1998;  7 609-614
• 8 Hakuba A, Liu S. The orbitozygomatic infratemporal approach: a new surgical technique.  Surg Neurol. 1986;  26 271-276
• 9 Hakuba A, Tanaka K. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernus sinus.  J Neurosurg. 1989;  71 699-704
• 10 Kojima M. Incidence of an intraorbital tumor, ophthalmological [Jpn].  Mook. 1980;  13 141-148
• 11 Maroon J C, Kennerdell J S. Lateral microcrosurgical approach to intraorbital tumors.  J Neurosurg. 1976;  44 556-561
• 12 Maroon J C, Abala A A. Tumor of the orbit. In: Youmans JR Neurological Surgery. Vol. 4. Philadelphia, PA; WB Saunders 1982: 2882-2892
• 13 Maroon J C, Kennerdell J S. Surgical approach to the orbit: indications and techniques.  J Neurosurg. 1984;  60 1226-1235
• 14 Natori Y, Rhoton Jr A L. Transcranial approach to the orbit: microsurgical anatomy.  J Neurosurg. 1994;  81 78-86
• 15 Natori Y, Rhoton Jr A L. Microsurgical anatomy of the superior orbit fissure.  Neurosurgery. 1995;  36 762-775
• 16 Yoshimoto S. Approach to an intraorbital tumor.  No Shinkei Geka. 1989;  16 7-13