Tumors and Pseudotumors of the Orbit and their Surgical Removal

Abstract

Purpose: To determine the share of malign and benign formations of the orbit and to select their optimum surgical intervention. Design: Retrospective observation of a case series. Methods and subjects: The authors evaluated a set of 100 tumors and pseudotumors in 93 patients who were operated on at the Central Military Hospital over the period of 13 years (1982-1994). The average age of patients (56 men and 37 women) was 45 years. Results: 59 primary orbital tumors, 41 secondary tumors, no metastases observed. There were 27 malign tumors. Most of the 29 benign neoplasms were meningeomas (10) and hemangiomas (9). The rest of the tumors of the orbit (12) were operated for granulomas (4), pseudocholesteatomas (3) and dermoid cysts (3), papilloma of the paranasal sinuses (1) and epidermoid cyst of the orbit (1). There were 32 muco- and pyoceles of frontal sinuses and ethmoid cells. We applied the following surgical methods: anterior and lateral orbitotomy, exenteration and extended exenteration of the orbit, rhinologic surgical techniques, partial and complete transcranial orbitotomy and a combination of several surgical methods. Seven patients operated for malignant neoplasm survived five years after the operation (25.9%). There are no reports on five other operated patients. Recurrence of benign tumors was found three times (10.3%), and once (8.3%) for the rest of tumors. As far as muco- and pyoceles are concerned, no recurrence has been ascertained. Conclusion: Our set comprised 59 primary orbital tumors, 41 secondary tumors and, metastases were not found. Successful surgical treatment of tumors and pseudotumors of the orbit lies in the exact diagnosis, the choice of convenient surgical methods and appropriate interdisciplinary cooperation. With regard to the small recurrence rate in all tumors and to the time of survival in malign neoplasms, the therapeutic methods we used can be considered as useful and contributing. died of another disease two years after the operation mentioned above and there are no reports on two others. Postoperational irradiation was applied in 5 patients (i.e. half of the total number only). The reasons were as follows: actinotherapy was contraindicated in four cases and one case was not considered as suitable. This decision proved correct as the last mentioned patient has been living for six years since the operation without any recurrence. Carcinomas of the nose and paranasal sinuses were treated surgically in 8 cases. Six of them were living for more than three years, two for more than 5 years. This group of malign tumors will be discussed in more details hereinafter. In four cases, the eye bulb was deviated before the surgery. Adenoid cystic carcinoma of the lacrimal gland caused deviation of the eye in all three cases. In all cases of adenoid cystic carcinomas of the lacrimal gland, exenteration of the orbit followed by irradiation was performed in all patients.