• Nicola Montano, Liverana Lauretti, Quintino Giorgio D'Alessandris, Mario Rigante, Fabrizio Pignotti, Alessandro Olivi, Gaetano Paludetti, Roberto Pallini, and Eduardo Fernandez.
• Institute of Neurosurgery, Catholic University, Rome, Italy.
• World Neurosurg. 2018 Nov 1; 119: e449-e458.

ObjectiveThe orbital cavity is an anatomically complex region and an area of interest of many specialists, each of whom is familiar with specific surgical approaches.MethodsWe retrospectively reviewed clinical and outcome data of 70 patients who underwent surgery for resection of an orbital tumor with a mean follow-up of 111.9 ± 79.6 months. The clinical outcome was reported and the role of sex, age, histology, tumor location, tumor size, and surgical approach on the extent of tumor removal was assessed.ResultsTotal removal was achieved in 74.3%, subtotal removal in 20%, and partial removal in 5.7% of patients. A fronto-orbital craniotomy was used in 57.1% of cases, frontal approach in 17.1%, fronto-orbit-zygomatic approach in 10%, and endoscopic endonasal approach in 11.4%. Complications included visual acuity decrease (4.3%), cerebrospinal fluid leak (4.3%), nerve palsy (10%; supra-orbital nerve 4.3%; frontal branches of facial nerve 2.9%, third cranial nerve 2.9%), and enophthalmos (1.4%). Lateral orbitotomy, combined fronto-orbital and maxillotomy, and trans-eyelid approaches were used in the remaining cases. The fronto-orbital, frontal, and lateral orbitotomy approaches were associated with greater rates of total resection as compared with the fronto-orbit-zygomatic approach, which was used in difficult cases in which the tumor involved several regions.ConclusionsWe recommend, 1) the endoscopic endonasal approach for primary orbital tumors located in the medial or inferior orbital walls without extra-orbital extension; 2) the trans-eyelid approach for tumors of the upper and upper-lateral quadrants extraconally located, and 3) the fronto-orbital approach for intraconally located tumors involving more than one quadrant.Copyright © 2018 Elsevier Inc. All rights reserved.

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