Evolution of an Orbital Apex Tumor Over a Decade

Two cases of retrobulbar meningioma excised by skull base approaches

We present two cases of orbital meningioma which were totally excised by a neurosurgical and craniomaxillofacial team using skull base approaches.

Primary optic nerve tumours

PURPOSE OF REVIEW

Advances have been made in the treatment of primary optic nerve tumours. With a focus on the last few years' publications, recommendations for clinical management are being developed.

RECENT FINDINGS

In low-grade optic nerve glioma, two divergent developments are observed: an increasing reluctance in treating such tumours because of reports about treatment toxicity (secondary tumours, moyamoya syndrome) and a steady and marked improvement both in radiotherapy and chemotherapy. Many reports on beneficial effects of radiotherapy on optic nerve meningioma have been published. Radiotherapy does not only preserve but in many cases even improves or restores visual function and has, therefore, become the therapy of choice in this tumour.

SUMMARY

Establishing a treatment plan in cases of optic nerve glioma is difficult and must be made on an individual basis. Although both chemotherapy and radiotherapy can stabilize and sometimes improve vision in progressive tumours, chemotherapy is the preferred modality in children younger than 9 years and in patients with neurofibromatosis 1. In functionally progressive optic nerve meningioma with useful visual function, multifractioned stereotactic conformal radiotherapy is the treatment of choice.

Orbital Decompression as an Alternative Management Strategy for Patients with Benign Tumors Located at the Orbital Apex

PURPOSE

Tumors located in the intraconal portion of the orbital apex, especially those inferior to the optic nerve, can be difficult to access surgically, carrying a significant risk of ocular morbidity. The purpose of this study was to investigate outcomes in 5 patients with benign-appearing but symptomatic tumors located in the intraconal portion of the orbital apex in which orbital decompression was performed as an alternative management strategy to resection.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Five patients were diagnosed with a compressive optic neuropathy secondary to a benign-appearing tumor at the orbital apex.

INTERVENTION

Each patient underwent surgical decompression of the affected orbit. None of the patients had the tumor biopsied or resected.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (VA), pupillary responses, visual fields (VFs), color vision, and orbital imaging.

RESULTS

Each of the patients demonstrated improvement in visual function, as measured by VA, VFs, and, in some cases, color vision. One patient required a second orbital decompression for recurrent optic neuropathy 4 years after the initial decompression. Complications included ptosis and enophthalmos in 2 patients and diplopia in the extreme right gaze in 1 patient.

CONCLUSIONS

Orbital decompression is a therapeutic option for patients with compressive optic neuropathies from benign orbital apex tumors, offering potential improvement in optic nerve function while sparing morbidity from attempts at surgical resection.