SURGICAL APPROACHES TO ORBITAL TUMORS

Abstract

Orbital tumor removal remains one of the most challenging aspects of ophthalmic plastic and reconstructive surgery. Kronlein, 19 in 1888, described the removal of the lateral orbital wall, allowing access for the removal of posterior orbital tumors for the first time. Refinement of orbital surgery has continued over the past century with improvement in imaging for localization of tumors and instrumentation for improved surgical extirpation. Recent advancements in orbital tumor sugery include the use of smaller or hidden incisions, the more widespread application of the CO 2 laser as a dissection instrument, intraoperative computerized tumor location mapping devices, and continued multidisciplinary efforts in obtaining access to tumors. The location of the orbital tumor remains the primary factor in the determination of the surgical approach for tumor excision. Other criteria include the size of the tumor, probable histopathology, signs of vision impairment, tumor invasion of surrounding tissues, and involvement of structures contiguous to the orbit. Radiographic imaging is, therefore, an essential component of the preoperative work-up. A comprehensive approach to the surgical removal of orbital tumors is discussed, with an emphasis on newly described techniques.