Solitary Fibrous Tumors of the Lacrimal Drainage System With Variable Orbital and Sinonasal Extensions: Combined External and Endoscopic Surgical Approach.

Abstract

To report techniques and outcomes of a combined external and endoscopic surgical approach in the management of solitary fibrous tumors of the lacrimal drainage system with variable orbital and sinonasal extensions. Biopsy proven cases of solitary fibrous tumors of the lacrimal drainage system involving the lacrimal sac and the nasolacrimal ducts with an orbital, sinonasal, or intranasal extension were studied. Parameters assessed include patient demographics, clinical presentation and course, operative techniques, complications, postoperative adjuvant therapies and outcomes. The technique is described in 3 patients. Two patients had massive orbital extension and one had gross sinonasal extension. Nasolacrimal duct extension was involved in all the patients with intranasal extension in 2 patients. External approach was used to access the lacrimal sac and the orbital components while the endoscopic approach was used to assess the orbital clearance and manage the sinonasal extension and the nasolacrimal duct excision up to the inferior meatus. Following complete excision, additional biopsies were performed from the adjacent bones and sinonasal tissues. A detailed histopathology with immunohistochemistry is essential for not only the diagnosis but also to assess the margin clearance. There were no major postoperative complications. All the patients were advised for postoperative adjuvant external beam radiotherapy. At the last follow-up, none of the patients had any clinical or endoscopic evidence of a recurrence. A combined external and endoscopic approach en-block excision is most suitable management modality for solitary fibrous tumors involving the lacrimal sac and the nasolacrimal ducts with orbital and sinonasal extension.