Optimising surgical approaches to the orbit — a retrospective analysis of a series of forty orbital tumours

Abstract

Background: This study aimed to analyse the influence of location, pathology, and approach on the extent of resection of orbital tumours. Material and methods: We have conducted a retrospective analysis of the clinico-radiological features of all orbital tumours operated between January 2012 and December 2019. Frontotemporal craniotomy with orbitotomy was performed for almost all lesions, except those limited to the lateral compartment (lateral orbitotomy), superior compartment (mini-craniotomy), and inferior medial compartment (transconjunctival/endoscopy). Statistical Analysis System (SAS) version 9.4 was used for analysis, and a p-value < 0.05 was considered to be statistically significant. The study was approved by the Institutional Review Board (3/10/2020). Results: Our study group comprised forty patients with a mean age of 40.89 years ± 19 years. Of the forty tumours, 21 (52.5%) cases were primary tumours of the orbit, and 19 (47.5%) were secondary tumours. The majority, 27 (67.5%), of the tumours were extraconal in location. The two most common presenting symptoms were proptosis (36/40; 90%) and visual blurring (30/40; 75%). The majority of the patients could be successfully operated through a fronto-tempero-orbital approach with or without removal of zygoma (28/40; 70%). Meningioma was the most common histology (45%), followed by schwannoma and lacrimal gland tumours (10%). Primary orbital tumours (15/21; 71.6%) and intraconal tumours (9/13; 69.23%)were associated with greater rates of gross total removal (GTR). GTR in sphenoorbital meningiomas was poor (2/17; 11.8%). Conclusion: Intraconal primary benign orbital tumours have a better chance of total gross removal. A frontotempero- orbital approach with or without removal of zygoma provides adequate exposure for the majority of the tumours.