Arai H, Sato K, Katsuta T, Rhoton A L
Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Neurosurgery. 1996 Dec;39(6):1157-62; discussion 1162-3. doi: 10.1097/00006123-199612000-00018.
We present our microsurgical lateral orbital approach for intraorbital lesions, with special emphasis on the microanatomy of the orbit.
Among 26 patients, such lesions included tumors of the lacrimal glands, cavernous angioma, meningioma, neuroma, and other tumors. These intraorbital lesions were removed through a 35- to 40-mm lateral skin incision, and this was followed by lateral orbitotomy featuring a microsurgical dissecting technique. If it was necessary to gain access to the deep lateral portion of the muscle cone, the lateral orbitotomy was extended to the anterior temporal dura. There are two microsurgical routes into the muscle cone, one above and the other below the lateral rectus muscle. The structures encountered along these two routes were demonstrated in an anatomic study of the orbit in cadavers.
Lesions located in the lateral compartment of the orbit could be exposed through lateral orbitotomy and were completely removed in most cases. Complications in our series of 26 patients included one case of postoperative visual impairment, one case of tonic pupil, and three cases of transient impairment of eye movement.
We think that, with an intimate understanding of the anatomy of the orbit, intraorbital lesions located in the lateral compartment of the orbit, and even those in the lateral apex, can be safely removed through lateral orbitotomy.
我们介绍用于治疗眶内病变的显微外科外侧眶入路，特别强调眼眶的显微解剖。
26例患者的此类病变包括泪腺肿瘤、海绵状血管瘤、脑膜瘤、神经瘤及其他肿瘤。通过35至40毫米的外侧皮肤切口切除这些眶内病变，随后采用显微外科解剖技术进行外侧眶切开术。若有必要进入肌锥的外侧深部，外侧眶切开术则延伸至颞前部硬脑膜。有两条进入肌锥的显微外科路径，一条在直肌上方，另一条在直肌下方。在尸体眼眶解剖研究中展示了沿这两条路径所遇到的结构。
位于眼眶外侧间隙的病变可通过外侧眶切开术暴露，多数情况下可完全切除。我们这组26例患者的并发症包括1例术后视力损害、1例强直性瞳孔和3例眼球运动短暂损害。
我们认为，充分了解眼眶解剖结构后，位于眼眶外侧间隙甚至外侧尖部的眶内病变可通过外侧眶切开术安全切除。
