Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Oper Neurosurg (Hagerstown). 2019 Jun 1;16(6):685-691. doi: 10.1093/ons/opy199.
The lateral orbitotomy approach (LOA) is often used for accessing the orbital contents and middle skull base; however, most prior descriptions of the LOA involve complete drilling of the lateral orbital wall. This practice requires retraction of the orbital contents and produces postoperative diplopia that the patient experiences for a limited time.
To describe a modified LOA with partial sparing of the lateral orbital wall for accessing lesions of the superior orbital fissure (SOF).
One patient with a progressively enlarging SOF lesion and visual loss underwent a modified LOA for resection. The orbital rim lateral to the SOF was removed as a bone flap, and the greater wing of the sphenoid inferior to the SOF was drilled to expose the lesion. The lateral orbital wall was thinned but was not completely removed. The orbital rim was resecured with miniplates and screws.
Gross total resection of the SOF mass was achieved without unnecessary exposure or retraction of the orbital contents. Histopathologic analysis of the resected mass was consistent with a cavernous hemangioma. The patient had a good cosmetic outcome without complication.
Modified LOA with partial sparing of the lateral orbital wall is a feasible approach for lesions of the SOF.
外侧眶切开术（LOA）常用于进入眶内容物和中颅底；然而，大多数关于 LOA 的描述都涉及到外侧眶壁的完全钻孔。这种做法需要牵拉眶内容物，并导致患者在有限的时间内出现术后复视。
描述一种改良的 LOA，部分保留外侧眶壁，用于进入眶上裂（SOF）病变。
1 例逐渐增大的 SOF 病变伴视力丧失患者接受改良 LOA 切除。去除 SOF 外侧眶缘作为骨瓣，蝶骨下 SOF 下方的蝶骨大翼钻孔以暴露病变。外侧眶壁变薄但未完全切除。用微型板和螺钉重新固定眶缘。
实现了 SOF 肿块的大体全切除，而无需不必要的眶内容物暴露或牵拉。切除肿块的组织病理学分析与海绵状血管瘤一致。患者术后外观良好，无并发症。
部分保留外侧眶壁的改良 LOA 是一种可行的 SOF 病变入路。
