Ponto K A, Brockmann M A, Koutsimpelas D, Heider J, Ringel F A, Heindl L M, Kakassery V
Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland.
Ophthalmologe. 2021 Oct;118(10):995-1003. doi: 10.1007/s00347-021-01386-5. Epub 2021 Apr 23.
The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid complications in large invasively infiltrating tumors. In the case of benign tumors, the indications for surgery depend mostly on the clinical symptoms and cosmetic esthetic disfigurement. In the present article the preoperative examinations as well as surgical access approaches to different orbital regions, endoscopic procedures and methods of intraoperative navigation are presented. Magnetic resonance imaging is the instrument of choice, whereby in many cases computed tomography (CT) adds further information. Depending on the indications, diffusion-weighted sequences, CT angiography and digital subtraction angiography (DSA, catheter angiography) are added to the preoperative diagnostics. For space-occupying lesions located anterior to the bulbar equator, an anterior orbitotomy can be performed transconjunctivally or transpalpebrally. A lateral orbitotomy is used to reach lateral, laterocranial, and lateroinferior orbital segments, whereas transcranial approaches are suitable for processes located far posterior and for those with retro-orbital intracranial extension as well as for processes in the optic foramen/superior orbital fissure. The indications for an endonasal access approach are processes medial to the bulb or optic nerve and up to the orbital apex. A transantral access can be chosen for caudal, mediolateral, and medioinferior space-occupying lesions. Modern orbital surgery is complemented by endoscopic procedures and intraoperative navigation. Orbital tumors belong to the interdisciplinary relevant diseases. Therefore, an optimal management takes place at specialized multidisciplinary centers.
眼眶肿瘤手术的适应证包括进行切开活检以确诊，对于可手术切除的恶性肿瘤，则需完整切除或减瘤以避免大型浸润性肿瘤出现并发症。对于良性肿瘤，手术适应证主要取决于临床症状和美容方面的毁容情况。本文介绍了术前检查以及针对不同眼眶区域的手术入路、内镜手术和术中导航方法。磁共振成像为首选检查手段，在许多情况下计算机断层扫描（CT）可提供更多信息。根据适应证，术前诊断还可增加弥散加权序列、CT血管造影和数字减影血管造影（DSA，导管血管造影）。对于位于眼球赤道前方的占位性病变，可经结膜或经睑进行前路眼眶切开术。外侧眼眶切开术用于到达眼眶外侧、颅外侧和眶外下部分，而经颅入路适用于位于后方较远的病变、伴有眶后颅内扩展的病变以及视神经管/眶上裂处的病变。鼻内镜入路的适应证为位于眼球或视神经内侧直至眶尖的病变。对于占据尾侧、中外侧和中下空间的占位性病变，可选择经鼻窦入路。现代眼眶手术辅以内镜手术和术中导航。眼眶肿瘤属于跨学科相关疾病。因此，最佳治疗应在专业的多学科中心进行。
