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Deep transorbital approach to the apex and cavernous sinus
R A Goldberg1, N Shorr, A C Arnold
1Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, California 90095, USA.
Ophthalmic Plastic and Reconstructive Surgery
|October 23, 1998
Summary
This study presents a modified lateral orbitotomy approach for orbital apex tumors, enabling successful removal of previously inoperable tumors with preserved or improved patient function.
Area of Science:
- Neurosurgery
- Ophthalmology
- Surgical Oncology
Background:
- Orbital apex tumors pose significant surgical challenges due to limited access via standard approaches.
- The transcranial approach is optimal only for superomedial tumors and involves extensive dissection.
Observation:
- A modified lateral orbitotomy, involving marginotomy and sphenoid wing removal, provides enhanced exposure of the lateral orbital apex.
- This technique allows for en face removal of tumors, preserving critical neurovascular structures.
Findings:
- Four benign orbital apex tumors, including two extending into the cavernous sinus, were successfully removed using the described approach.
- Three patients with previously deemed inoperable tumors achieved successful resection.
- Visual and motor functions were maintained or improved in most patients, with successful nerve repair in one case.
Implications:
- This modified transorbital approach offers a viable alternative for managing challenging orbital apex tumors.
- It expands surgical options for tumors previously considered inoperable, potentially improving patient outcomes and function.