Anterior and Anterolateral Skull Base Surgery
Anterior and Anterolateral Skull Base Surgery
Object. Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of the reconstruction necessary following this resection. The authors studied this factor in a series of patients.
Methods. The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbit-related outcome was strongly associated with resection of the orbital floor and with resection of two thirds or more of two or more orbital walls but not with the presence of absence or orbital reconstruction. The latter finding, however, is likely a function of selection bias.
Conclusions. In most patients after partial excision of the orbital bones, elaborate reconstruction is not necessary. Isolated medial and lateral orbital wall defects or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple wall resection, primary reconstruction is recommended.
During resection of anterior and anterolateral skull base tumors, it is not uncommon that the orbit be entered. Oncologically sound removal of these tumors, the majority of which are malignant, typically requires resection of one or more of the bony orbital walls. This may be necessary due to direct orbital involvement by the tumor, causing erosion of the orbital bones, or it may be planned so as to include a noninvolved margin of resection. Controversy exists regarding the timing, need for, and extent of orbital reconstruction following these partial orbital bone resections. To clarify these issues a retrospective review of 56 consecutive patients who underwent partial resection of the orbital walls was undertaken. The nature and location of the lesions, the extent of orbital resection and dissection, and ophthalmological outcome are presented.
Object. Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of the reconstruction necessary following this resection. The authors studied this factor in a series of patients.
Methods. The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbit-related outcome was strongly associated with resection of the orbital floor and with resection of two thirds or more of two or more orbital walls but not with the presence of absence or orbital reconstruction. The latter finding, however, is likely a function of selection bias.
Conclusions. In most patients after partial excision of the orbital bones, elaborate reconstruction is not necessary. Isolated medial and lateral orbital wall defects or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple wall resection, primary reconstruction is recommended.
During resection of anterior and anterolateral skull base tumors, it is not uncommon that the orbit be entered. Oncologically sound removal of these tumors, the majority of which are malignant, typically requires resection of one or more of the bony orbital walls. This may be necessary due to direct orbital involvement by the tumor, causing erosion of the orbital bones, or it may be planned so as to include a noninvolved margin of resection. Controversy exists regarding the timing, need for, and extent of orbital reconstruction following these partial orbital bone resections. To clarify these issues a retrospective review of 56 consecutive patients who underwent partial resection of the orbital walls was undertaken. The nature and location of the lesions, the extent of orbital resection and dissection, and ophthalmological outcome are presented.
