Size, location of orbital tumors key to removal

Key Points

Las Vegas-The choice of surgical approach or combination of approaches to orbital tumors is dictated by the size and location of the lesion or the area being pursued, according to Roberta E. Gausas, MD, who described the various surgical options at the American Academy of Ophthalmology annual meeting.

She said she believes that, to select the surgery best suited for a patient, it is best to understand the history of orbital surgery. Kronlein pioneered the lateral bone flap in 1888 for dermoid tumors of the orbit; this technique later was modified by Berke for improved exposure and cosmesis and then was modified further by Stallard and Wright, she explained.

Moving incision inward

Another modification described by Pelton and Patel is achieved by bringing the lid crease incision in medially, which provides access to the medial intraconal space or the optic nerve. "This approach involves a blunt dissection in a plane between the medial rectus muscle and the superior oblique tendon. In a patient with a superomedial extraconal lesion causing downward displacement of the globe, the approach provided excellent exposure for removal of the tumor," Dr. Gausas said.

The incision also can be moved farther in past the eyelids to the conjunctiva via a conjunctival incision at the limbus with muscle disinsertion. "This provides excellent access to the retrobulbar intraconal orbital space," she said. Dr. Gausas described a case in which a lesion lateral to the optic nerve was located by disinserting the lateral rectus muscle, which provided excellent exposure and removal of the lesion.