Goldberg Robert A, Rootman Daniel B, Nassiri Nariman, Samimi David B, Shadpour Joseph M
Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA.
J Ophthalmol. 2014;2014:424852. doi: 10.1155/2014/424852. Epub 2014 Apr 14.
To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females) underwent tumor removal through eyelid crease (17 eyes), conjunctival (nine eyes), lateral canthal (two eyes), and transcaruncular (two eyes) approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range) age and follow-up duration were 48.5 (31-87) years old and 24.5 (4-375) weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases), pleomorphic adenoma (5 cases), solitary fibrous tumor (4 cases), neurofibroma (2 cases), schwannoma (2 cases), and orbital varix (1 case). None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.
介绍我们使用微创软组织入路联合（有时在局部麻醉下）切除中深部眼眶肿瘤的经验。方法。在这个回顾性病例系列中，30例患者（13例男性和17例女性）通过眼睑皱襞入路（17只眼）、结膜入路（9只眼）、外眦入路（2只眼）和经泪阜入路（2只眼）进行肿瘤切除。所有肿瘤均位于眼眶后半部。6例在局部阻滞监护麻醉下切除，24例在全身麻醉下切除。结果。中位（范围）年龄和随访时间分别为48.5（31 - 87）岁和24.5（4 - 375）周。在最近一次随访时，除1例患者外，所有患者的视力和眼球运动均有改善或无明显变化。确诊的病理结果显示海绵状血管瘤（15例）、多形性腺瘤（5例）、孤立性纤维瘤（4例）、神经纤维瘤（2例）、神经鞘瘤（2例）和眼眶静脉曲张（1例）。所有患者均未复发。结论。进行眶缘切开术可增加术中对深部眼眶的暴露，但会增加大量时间和并发症。良性眼眶肿瘤通常可通过小的软组织切口安全切除，无需去除骨质且可在局部麻醉下进行。
