Intact Excision of Large Extraconal Orbital Tumors Without Osteotomy: A "Hook-and-Lift" Technique

The purpose is to evaluate the safety and outcomes of a minimally invasive "hook-and-lift" technique for intact excision of large extraconal orbital tumors without the use of osteotomy.

Retrospective review of patients with histologically confirmed solitary fibrous tumors or Schwannomas excised macroscopically intact using a "hook-and-lift" technique. Inclusion criteria were noncompressible lesions ≥25 mm in maximum dimension and/or occupying more than two-thirds of the orbit, those predominantly in the extraconal space, and those amenable to circumferential dissection.

Twenty patients (13 solitary fibrous tumors and 7 Schwannomas) met the inclusion criteria with 11 (55%) females presenting at a mean age of 48.2 (range, 23-78) years. Most presented with nonaxial globe displacement (90%) and reduced ocular motility (65%), while visual acuity was preserved (mean LogMAR, 0.08). The largest tumor dimension was an average of 29.3 (range, 25-40) mm, and the mean estimated volume was 6.1 (range, 1.1-15.7) mL. Depending on location, macroscopically intact without osteotomy was performed through an upper eyelid skin-crease incision (13/20), lower lid swinging flap (5/20), or retrocaruncular approach (2/20). Postoperative complications include persistent moderate ptosis (2) and motility deficit (2), including an acquired Brown syndrome; there was no impairment of vision; and no tumor recurrences were observed at a mean follow-up of 4.2 years.

In appropriately selected cases, the "hook-and-lift" technique provides a safe and effective method for macroscopically intact excision of large and firm extraconal orbital tumors. The technique avoids the morbidity associated with periorbital osteotomy and can yield excellent functional outcomes.