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. 2012;5(2):212-6.
doi: 10.3980/j.issn.2222-3959.2012.02.19. Epub 2012 Apr 18.

Transcranial surgery through pterional approach for removal of cranio-orbital tumors by an interdisciplinary team of nurosurgeons and ophthalmologists

Yan Liu  1 , Jiang-Rong Ma, Xue-Liang Xu
Affiliations

Transcranial surgery through pterional approach for removal of cranio-orbital tumors by an interdisciplinary team of nurosurgeons and ophthalmologists

Yan Liu et al. Int J Ophthalmol. 2012.

Abstract

Aim: To investigate the specialty of transcranial surgery through pterional approach for removal of cranio-orbital tumors, introduce the ophthalmological experiences of entering the orbit to reduce the incidence rate of associated complications of this operation.

Methods: We performed a retrospective analysis of a series of 37 cases involving patients who underwent transcranial surgery through pterional approach for treatment of cranio-orbital tumors in our department in the past 8 years. Pterion approach craniotomy was performed to all patients. After removing tumors in the skull by the neurosurgeon, ophthalmologist removed tumors in orbit. We took measures below to decrease complications, including grounding optic canal through an abrasive drilling when necessary, hanging various extraocular muscles to be exposed for protection, refrigerating by refrigeration heads to remove tumors, at last sewing up orbit septum after surgery.

Results: Tumors were removed completely in 32 cases, and incomplete in 5 cases due to extensive invasion into the cavernous sinus or sphenoid sinus. Of all the cases, benign tumors were demonstrated in 28 cases (75.6%, 28/37) and malignant in 9(24.3%, 9/37). The most common lesion type was meningioma in 11 cases (29.7%, 11/37). Extraocular muscles (EOM) impairment, occurring in 21 cases (56.7%, 21/37), was the most frequent postoperative complication. The most serious consequence was vision loss occurred in 4 cases (10.8%, 4/37). Other complications, such as 11 cases of transient blepharoptosis 29.7% (11/37), 5 cases of mydriasis in 13.5% (5/7); 2 cases of cerebrospinal rhinorrhea in 5.4% (2/37).

Conclusion: Cranio-orbital tumors can be removed completely using transcranial approach, and the pterional approach offers excellent exposure. Cooperation of interdisciplinary team of neurosurgeons and ophthalmologists conduces to full use of respective professional advantages. The experience of ophthalmic operation technology can decrease occurrence of ocular complications after surgery.

Keywords: complications; cranio-orbital tumors; ophthalmic operational experiences; transcranial operation.

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Figures

Figure 1
Figure 1. After performing skin incision, the temporalis muscle and fascia are incised vertically
1: Remove the skull; 2: The supraorbital margin of frontal bone are exposed.
Figure 2
Figure 2. Part of cerebrospinal fluid is aspirated after opening the duramater, then important structure with orbit is exposed
1: Internal carotid; 2: Internal jugular vein; 3: Left optic nerve; 4: Right optic nerve; 5: Optic chiasma.
Figure 3
Figure 3. Separate and protect the extraocular muscle
1: Lateral rectus; 2: Superior rectus; 3: Levator muscle; 4: Medial rectus.
Figure 4
Figure 4. Pull away extraocular muscles to side of tumor.
Figure 5
Figure 5. Following exposure of the anterior portion of the tumor, a standard retinal cryoprobe was used to freeze the tumor and pull it out carefully.
Figure 6
Figure 6. Patient with exophthalmia
A: Before surgery; B: After surgery exophthalmia was alleviated.
See this image and copyright information in PMC

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