title: Transorbital approach without craniotomy to orbital tumors with extradural intracranial extension.
abstract: OBJECTIVE
  To review indications and clinical outcomes in a series of orbitocranial tumors treated surgically through a transorbital extradural approach without craniotomy.
  
  
  METHODS
  In this retrospective case series, all patients who underwent surgery through a transorbital extradural approach without craniotomy for benign orbitocranial tumors involving the dura or extending into the anterior or middle cranial fossae were analyzed.
  
  
  RESULTS
  Twenty-seven patients (20 females and 7 males) were included. Median age was 47.0 years (range: 6-74 years) and median follow-up time was 43.5 months (range: 3-148 months). The median preoperative best-corrected visual acuity (logMAR) was improved from 0.35 (range: 0-2.6) to 0.1 (range: 0-2.6) at the last follow-up (p < 0.03). The mean ± SD preoperative exophthalmos significantly decreased from 20.4 ± 3.4 mm to 13.1 ± 3.5 mm at the last follow-up visit (p < 0.01). Four postoperative complications were noted and included one case each of ptosis, numbness, diplopia (transient for 6 months), and cranial nerve VI palsy (transient for 4 months).
  
  
  CONCLUSIONS
  The transorbital extradural approach provides access to the deep orbit and adjacent extradural cranial spaces. Benign orbital tumors that have eroded through the orbital roof, are located in the orbital apex abutting the anterior cavernous sinus and tumors requiring debulking are all processes that can be potentially approached through the transorbital extradural route. Compared to open craniotomy, the incision is smaller, the access more direct and specific risks of open craniotomy are reduced.
authors.affiliation: Department of Ophthalmology, CHA Bundang Medical Center, CHA University , Bundang-gu, Seongnam , South Korea and.
authors.forename: Helen
authors.initials: H
authors.lastname: Lew
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rootman
authors.forename: Nariman
authors.initials: N
authors.lastname: Nassiri
authors.forename: Alice
authors.initials: A
authors.lastname: Goh
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology
keywords: Craniotomy; deep orbital approach; orbitocranial tumors; transcranial approach; transorbital extradural approach