engleski

KEYHOLE CONCEPT IN ORBITAL TUMOR SURGERY

Objective: In order to minimize surgical invasivness we applied eyebrow keyhole approach to orbital tumors and compared the results and complications with standard pteryonal approach. Patients and methods: The eyebrow keyhole approach (EKA) presumes skin incision in the lateral two thirds of eyebrow followed by small supraorbital cranio- and orbitotomy. Using this approach the authors operated on 46 patients with different orbital space-occupying lesions. The patients presented with proptosis 44/46 (96%), retrobulbar pain 7/46 (15%), loss of visual acuity from ambliopia 14/46 (30%) to amaurosis 6/46 (13%) and disturbance of ocular motility and diplopia 14/46 (30%). The diagnosis was established by MR in 24/46 (52%), CT 26/46 (57%), CT and MR 15 (33%), and DSA 4/46. The microsurgical total 40/46 (87%), or partial 6/46 (13%) tumor removal has been performed through EKA in all patients ; osteoclastic cranioorbitotomy with palacos reconstruction 22/46 (48%) and osteoplastic cranioorbitotomy in 24/46 (52%). The most frequent findings were hemangiomas 9/46 (20%), meningeomas 9/46 (20%), and neurinomas 7/46 /15%). The major complication was CSF leakage 1/46 (2%). The minor complications include transient swelling 30/46 (65%), and transient ophtalmoparesis 28/46 (61%). Discussion: The various approaches have been developed in surgery of orbital tumors. The advantages and disadvantages of these approaches are continuosly reviewed, as search for new, improved, more sure and less invasive surgical strategies and technics. The application of microsurgical technics in orbital surgery has led to development of keyhole concept. In our experience EKA is safe procedure with low rate of complications when performed by experienced orbital tumor surgeon. Conclusion: EKA has several advantages (minor tissue damage, good orbital content exposure, shorter duration of surgery, faster postoperative recovery, and better cosmetic results) and no important disadvantages in comparison with standard larger surgical approaches.

key hole; orbital tumors; minimally invasive neurosurgery

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