Lateral approach to intraorbital lesions: anatomic and surgical considerations.
OBJECTIVE
We present our microsurgical lateral orbital approach for intraorbital lesions, with special emphasis on the microanatomy of the orbit.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Arai
H
H
Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Sato
K
K
Katsuta
T
T
Rhoton
A L
AL
D000328:Adult; D000368:Aged; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D009916:Orbital Diseases / Q000175:diagnosis / Q000601:surgery*; D010781:Photography; D014057:Tomography, X-Ray Computed