Lateral Orbitotomy for Removal of Sphenoid Wing Meningiomas Invading the Orbit

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons287-ons292 ◽  
Author(s):  
Giuseppe Mariniello ◽  
Francesco Maiuri ◽  
Enrico de Divitiis ◽  
Giulio Bonavolontà ◽  
Fausto Tranfa ◽  
...  
Keyword(s):  
Skin Incision ◽  
Tumor Extension ◽  
Orbital Cavity ◽  
Upper Eyelid ◽  
Anterior Clinoid Process ◽  
Select Group ◽  
Lateral Orbitotomy ◽  
Orbital Wall ◽  
Transcranial Approach

Abstract OBJECTIVE This study defines the indications, results, and limits of lateral orbitotomy coupled with resection of the sphenoid wing for removing lateral sphenoid wing meningiomas with intraorbital extension. METHODS Eighteen patients with lateral sphenoid wing meningiomas and tumor extension into the lateral or superolateral compartments of the orbital cavity were treated by microsurgical lateral orbitotomy and resection of the sphenoid wing without craniotomy. The approach consisted of a linear skin incision along the upper eyelid crease extending to 2 cm from the canthal angle and resection of the lateral orbital rim, lateral orbital wall, and infiltrated sphenoid wing. RESULTS A complete resection (Simpson I), including the infiltrated bone, dura, and periorbita, was obtained in 13 patients (72%); in the other 5 cases (28%), the tumor mass and most infiltrated dura were removed, but the entity of dural resection up to the normal tissue could not be exactly defined (Simpson II). Follow-up ranged from 5 to 17 years (mean 9.7 years). CONCLUSION A select group of lateral sphenoid wing meningiomas with tumor extension in the lateral or superolateral compartments of the orbital cavity may be successfully approached and removed through a lateral orbitotomy with resection of the sphenoid wing and without craniotomy. Cases with tumor extension to the anterior clinoid process and superior orbital fissure and those with extension medial to the axis of the optic nerve require a transcranial approach.

Sphenoorbital meningioma: surgical technique and outcome

2011 ◽  
Vol 114 (5) ◽  
pp. 1241-1249 ◽  
Author(s):  
Soichi Oya ◽  
Burak Sade ◽  
Joung H. Lee
Keyword(s):  
Surgical Technique ◽  
Visual Outcome ◽  
Sphenoid Bone ◽  
Wide Resection ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms

2021 ◽  
Vol 134 (1) ◽  
pp. 72-83 ◽  
Author(s):  
Murat Ulutas ◽  
Kadir Çinar ◽  
Ihsan Dogan ◽  
Mehmet Secer ◽  
Semra Isik ◽  
...  
Keyword(s):  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Target Area ◽  
Aneurysm Surgery ◽  
Operative Field ◽  
Anterior Circulation ◽  
Anterior Clinoid Process ◽  
Broad Perspective ◽  
Lateral Orbitotomy ◽  
Orbital Wall

OBJECTIVETransorbital approaches for neurosurgery have recently attracted attention and several anatomical studies have aimed to improve these techniques, but significant deficiencies in clinical practice remain, especially for aneurysm surgery. The authors present an alternative microsurgical route and the results of an analysis of patients with intracranial aneurysms who underwent a lateral transorbital approach (LTOA) using lateral orbito-zygoma-sphenotomy (LOZYGS).METHODSThe clinical and surgical results of a series of 54 consecutive patients with 1 or more aneurysms who underwent surgery via LTOA are reported. A lateral orbitotomy was performed after making a 3-cm skin incision parallel to the lateral orbital rim. A second bone flap, which included the zygoma and sphenoid bones that form the lateral orbital wall, was removed. The lesser sphenoid wing, including the anterior clinoid process, was fully drilled, except in cases of middle cerebral artery (MCA) aneurysms. Cisternal dissection was performed using the classic microsurgical technique starting from the proximal Sylvian fissure and carotid cistern. After the aneurysm was clipped following microsurgical principles, the dura mater was closed in a watertight fashion and 2-piece bone reconstruction was achieved.RESULTSSixty aneurysms in 54 patients were clipped using the LOZYGS route. Twenty-one aneurysms were located on the MCA, 30 on the anterior communicating artery, 8 on the internal carotid artery, and 1 at the apex of the basilar artery. The unruptured-to-ruptured aneurysm ratio was 17:43. The operative field was moved to the orbit using the LTOA to avoid interference by bone and muscle tissues. Early proximal control was achieved using a short working distance and direct exposure of the base of the cerebrum, without any requirement for retraction. Because different view angles and surgical corridors were used, no segment of the aneurysm or the parent artery remained unexposed. Therefore, the introduction of additional tools was not required.CONCLUSIONSThe LTOA allowed enhanced broad-perspective exposure of the operative field, early proximal control, and satisfactory surgical freedom. This alternative surgical approach safely exposed the target area and the operative field. The LOZYGS route is safe and effective for the LTOA and microsurgical clipping of anterior circulation aneurysms. According to the authors’ surgical experience and clinical experience, the LTOA can be considered an alternative surgical route to supratentorial aneurysm surgery.

Asian Upper Blepharoplasty in Women: A Comprehensive Approach for a Natural and Aesthetically Pleasing Outcome

2021 ◽  
Author(s):  
Chunmei Wang ◽  
Xiaoxia Mei ◽  
Lee L Q Pu
Keyword(s):  
Skin Incision ◽  
Comprehensive Approach ◽  
Asian Women ◽  
Orbicularis Oculi Muscle ◽  
Upper Eyelid ◽  
Cosmetic Procedure ◽  
Eyelid Skin ◽  
Upper Blepharoplasty ◽  
Levator Aponeurosis

Abstract Background Asian upper blepharoplasty is the most popular cosmetic procedure for Asian women. However, there is lack of standardized approach to this procedure and less than optimal results are still common. Objectives In this article, we introduce our comprehensive approach to Asian upper blepharoplasty in women and report our clinical outcomes with this approach. Methods Our comprehensive approach for Asian upper blepharoplasty in women includes: (1) To determine the height and length of the upper eyelid skin crease; (2) To create a more optimal anatomy of the upper eyelid by removing excess eyelid skin, a portion of the orbicularis oculi muscle and septal fat; (3) To reconstruct the desired anatomic structures of the upper eyelid skin crease through plication of the levator aponeurosis, if necessary, and closure of the upper eyelid skin incision through the septum and the mobile portion of the levator aponeurosis; (4) To add a medial epicanthoplasty if needed to enhance final cosmetic results. Results Over a 5-year period, 332 Asian women underwent upper blepharoplasty for creation of double eyelids, or conversion from less visible to more ideal double eyelids, by the authors with the above comprehensive approach. There were no surgical complications postoperatively and 326 patients (98.2%) rated satisfactory for their outcome during 5-year’s follow-up. Only 6 patients (1.8%) required surgical revision for asymmetry or less optimal shape of the upper eyelid. Conclusions Our comprehensive approach to Asian upper blepharoplasty can be used for Asian women with a natural and aesthetically pleasing outcome and low revision rates.

scholarly journals Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland

2019 ◽  
Vol 12 (3) ◽  
pp. 777-790
Author(s):  
Alexandre Anesi ◽  
Sara Negrello ◽  
Donatella Lucchetti ◽  
Giuseppe Pollastri ◽  
Lorenzo Trevisiol ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Lacrimal Gland ◽  
Open Angle Glaucoma ◽  
Acinic Cell Carcinoma ◽  
Upper Eyelid ◽  
Acinic Cell ◽  
Lateral Orbitotomy ◽  
Tender Mass ◽  
Magnetic Resonance Imaging Mri

To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We performed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 × 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up.

Management of meningiomas en plaque of the sphenoid wing

2006 ◽  
Vol 104 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Uta Schick ◽  
Joris Bleyen ◽  
Alan Bani ◽  
Werner Hassler
Keyword(s):  
Cavernous Sinus ◽  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Growth Patterns ◽  
Retrospective Case ◽  
Superior Orbital Fissure ◽  
Anterior Clinoid Process ◽  
Orbital Roof ◽  
Orbital Wall

Object The authors present their findings on growth patterns in a large series of surgically treated meningiomas en plaque of the sphenoid wing. Methods A retrospective case analysis was performed in 67 patients (53 of whom were female) harboring meningiomas en plaque originating from the sphenoid wing, who underwent surgery between 1991 and 2002. The standard surgical approach consisted of pterional craniotomy and extradural resection of any infiltrated bone. The intracranial tumor was removed, and the dura mater and bone were reconstructed. The follow-up period ranged from 6 to 118 months (mean 45.7 months). Total macroscopic resection was achieved in 40 patients. Forty-eight meningiomas extended to the orbital roof and/or the lateral orbital wall, 34 involved the extraconal space, and eight the intraconal space. Fifty-four tumors involved the superior orbital fissure, 46 the optic canal, and 21 the inferior orbital fissure. Twelve tumors infiltrated the cavernous sinus and 27 involved the anterior clinoid process. There were no deaths in this group of patients; the rate of minor morbidity was 11.9% and the rate of major morbidity was 3%. Subtotal resections were performed in 27 patients because there was intraorbital tumor (eight patients), tumor in the cavernous sinus (nine patients), tumor beyond the tentorial notch (three patients), tumor invading the superior orbital fissure (four patients), and tumor of the skull base (three patients). Five patients underwent postoperative three-dimensional conformal radiotherapy, which resulted in stable tumor volume at follow up. Tumor recurrence was identified in seven patients (10.4%) postoperatively (range of follow up 13–47 months). Conclusions The goal of surgery is complete tumor removal without morbidity. An exact analysis of tumor growth and its involvement of different structures is mandatory before performing surgery.

RESULTS OF INTRALESIONAL TRIAMCINOLONE ACETONIDE FOR CHALAZION TREATMENT

2011 ◽  
pp. 100-104
Author(s):  
Thi Thu Nguyen ◽  
Viet Hien Vo ◽  
Thi Em Do
Keyword(s):  
Success Rate ◽  
Key Words ◽  
Triamcinolone Acetonide ◽  
Lower Eyelid ◽  
Upper Eyelid ◽  
Interventional Trial ◽  
The Mean ◽  
First Time

The study use intralesional triamcinolone acetonide injection proceduce for chalazion treatment.1. Objectives: To evaluate results of intralesional triamcinolone acetonide injection for chalazion treatment. 2. Method: This noncomparative prospective interventional trial included 72 chalazions of 61 patients. 3. Results: 61 patients (72 chalazions) with 19 males (31.1%) và 42 females (68.9%), the mean age was 24 ± 9,78 years. 31.1% patients was the first time chalazion and 68.9% patients was more than one times chalazion including 78.6% patients was recurrent at the first position and 21.4% patients occur at new position. 72 chalazions with 16 (22.2%) chalazions was treated before and 56 (77.8%) chalazions wasn’t done that. 72 chalazions with 49 chalazions (68.1%) are local in upper eyelid and 23 chalazions (31.9%) are local in lower eyelid. The mean of chalazion diameter is 6.99 ± 3.03mm. Intralesional triamcinolone acetonide is injected to treat 72 chalazions with 16 (22.2%) chalazions are injected through the route of skin and 56 (77.8%) chalazions are injected through the route of conjunctiva. After 2 weeks follow-up, the success rate was 93.1% and 6.9% failed. 4. Conclusion: intralesional triamcinolone acetonide injection for chalazion treatment is really effective. Key words: chalazion, intralesional triamcinolone acetonide.

Endoscopy-assisted removal of periorbital inclusion cysts in children

2011 ◽  
Vol 7 (2) ◽  
pp. 161-164 ◽  
Author(s):  
George Chater-Cure ◽  
Caitlin Hoffman ◽  
Jared Knopman ◽  
Samuel Rhee ◽  
Mark M. Souweidane
Keyword(s):  
High Speed ◽  
Complete Removal ◽  
Skin Incision ◽  
Clinical Findings ◽  
Complete Excision ◽  
Alternative Approach ◽  
Cyst Recurrence ◽  
Scalp Incision ◽  
Access Technique

Object Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow. Methods Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1–2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface. Results Eight patients (5–33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months. Conclusions Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.

scholarly journals Double Rectangle Fascia Lata Frontalis Sling: A Rationale Approach for Ptosis

2021 ◽  
Vol 54 (01) ◽  
pp. 058-062
Author(s):  
Pawan Agarwal ◽  
Dhananjaya Sharma ◽  
Vikesh Agrawal ◽  
Swati Tiwari ◽  
Rajeev Kukrele
Keyword(s):  
Retrospective Study ◽  
Surgical Outcomes ◽  
Functional Outcomes ◽  
Fascia Lata ◽  
Modified Technique ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Light Reflex ◽  
Straight Line

AbstractBackground The purpose of this study was to evaluate the functional outcomes of a modified technique of double rectangle pattern for correction of severe ptosis.Methods This is a retrospective study over a period of 8 years including patients who underwent correction of ptosis by double rectangle using autologous fascia lata sling. Surgical outcomes were assessed postoperatively by distance from the corneal light reflex to the upper eyelid margin (MRD1) and levator function.Results Twenty-six eyelids were operated in 20 patients. There were 9 males and 11 females, with age ranging from 4 to 35 years. Preoperatively, all patients had poor MRD1 and poor levator function. Postoperative MRD1 was good in 13 patients (17 eyelids), fair in 5 (7eyelids), and poor in 2 patients (2 eyelids). Postoperative levator function was excellent in 12 patients (15 eyelids), good in 6 (9 eyelids), and fair in 2 patients (2 eyelids). At a mean follow-up of 12 months, adequate correction was achieved in 24 eyelids, and 2 eyelids had undercorrection.Conclusion Frontalis sling with a double rectangle is simple and more efficient, as it provides a straight line of pull to the eyelid for correction of severe ptosis.

A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis

2003 ◽  
Vol 98 (3) ◽  
pp. 290-293 ◽  
Author(s):  
Koichi Sairyo ◽  
Shinsuke Katoh ◽  
Tadanori Sakamaki ◽  
Shinji Komatsubara ◽  
Natsuo Yasui
Keyword(s):  
Clinical Outcome ◽  
Nerve Root ◽  
Clinical Results ◽  
Skin Incision ◽  
Endoscopic Technique ◽  
Spinal Instability ◽  
Nerve Roots ◽  
Content Type ◽  
Proximal Stump

✓ The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42–70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.

Customised gold weight eyelid implantation in paralytic lagophthalmos

2008 ◽  
Vol 122 (10) ◽  
pp. 1088-1091 ◽  
Author(s):  
N Jayashankar ◽  
K P Morwani ◽  
M J Shaan ◽  
S R Bhatia ◽  
K T Patil
Keyword(s):  
Visual Acuity ◽  
Prospective Study ◽  
Study Design ◽  
Study Group ◽  
Upper Eyelid ◽  
Eyelid Closure ◽  
Gold Weight ◽  
One Year ◽  
A Prospective Study

AbstractGold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import.Objective:We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure.Study design and setting:A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question.Results:Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases.Conclusion and significance:Customised gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.

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