An Introductory Overview of Orbital Tumors

, , , And , Departments of Neurosurgery and Ophthalmology, and Division of Neuropathology, University of Virginia Health Sciences Center, Charlottesville, Virginia

Neurosurg Focus. 2001;10(5) 

In This Article

Principles of Treatment

The best strategy for managing orbital tumors is largely determined by the nature of the lesion. Lesions best suited to medical treatment include the dysthyroid orbitopathies, infectious processes involving the orbit, such as mild cases of cellulitis, and inflammatory pseudotumors. Definitive surgical treatment remains the mainstay of therapy for the majority of symptomatic orbital tumors. The type of anesthesia and the most appropriate surgical approach to the lesion are dependent on its anatomical location, proximity to vital structures, and extent of involvement as visualized on CT scanning and MR imaging.

Orbital and nasal approaches can be warranted, especially when the tumor does not involve the apex or extend beyond the confines of the orbit.

Orbital approaches can be made more extensive when the lesion is posterior to the equator of the eye. A lateral orbitotomy, with temporary removal of the lateral orbit wall, may provide excellent exposure of the orbital contents, allowing for tumor resection without damage to the extraocular muscles or their nerve supply. This technique is useful for lesions in the lacrimal fossa and lateral orbit, including the areas above and below the optic nerve.

The transcranial approach is useful for the resection of medially situated lesions, especially those situated at the orbital apex or those involving the optic nerve. In this approach, it is important to establish the surgery-related goals preoperatively. Certainly, with a malignant process confined to the orbit, cosmesis is secondary to controlling the spread of disease, and it is important to attempt to determine the nature of the lesion prior to undertaking the operation.

Orbital exenteration is the excision of the eyelids and the removal of the conjunctiva, globe, optic nerve, extraocular muscles, the lacrimal gland, and all the soft tissues of the orbit. Careful consideration of a patient's ultimate prognosis should precede this surgical procedure.