gms | German Medical Science

Objective: A variety of tumours and pseudotumours can involve the orbit. They built a heterogeneous group classified as primary, secondary invading tumours and metastasis which can be inflammatory, cystic, benign or malignant. Often a complex involvement of the orbital content, the osseous orbital walls, cranial nerves and vascular structures like the cavernous sinus is present, which makes their complete resection difficult or sometimes impossible.

Methods: This series consists of 44 patients who were retrospectively analyzed over a 30-years period. Among 44 orbital tumours 23 (52%) were classified as primary tumours, 18 (41%) as secondary tumours originating in contiguous spaces and 3 (7%) as metastases. In 52 surgical procedures tumour exposure could be achieved by orbitotomy in 11 (21%) cases. A transcranial subfrontal, frontotemporal or pterional approach was adequate in 41 (79%). Surgery was indicated in eight individuals due to recurrent disease, a second-look surgery was required in one case and four biopsies were performed.

Results: 38 (86%) individuals presented with progressive proptosis as the most frequently symptom, followed by visual disturbance in 30 (68%), retrobulbar pain in 15 (34%), chemosis in 9 (20%) and amaurosis in 5 (11%) cases. 38 lesions (86 %) were benign mostly sphenoorbital meningiomas 15 (34%) and cavernomas 9 (20%). 6 (14%) orbital masses were malignant. Amongst these two embryonal rhabomyosarcoma and one PNET were diagnosed. A gross total resection was achieved in 32 (73%) patients; in 8 (18%) cases surgery was limited to partial resection. The majority of complications were transient with complete restitution, namely trigeminal irritation (13%), diplopia (11%), ptosis (11%) and impaired vision (9%). Rhinoliquorrhea occurred in 3 (7%) cases. Persistent functional deficit of cranial nerves were observed in 5 (11%) cases. Two patients died due to cerebral herniation and ARDS.

Conclusions: To minimize functional deficits and to prevent visual loss in the surgical treatment of orbital masses tumour location determines the recommended surgical approach. Lateral orbitotomy shows a low rate of operative morbidity but is only suitable for masses with involvement of the lateral orbital portion. Tumours located in the apical area, and those in the medial orbital compartment with contact to the optic nerve often require transcranial approaches. Thus, in most cases a satisfactory surgical outcome can be attained and the rate of persistent or fatal complications is low.