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An Alternate Approach to Surgical Excision for Radiographically Benign Orbital Apex Tumors

M. Camille Almond, MD; Alan G. Cheng, MD; Vivian Schiedler, MD; Bryan S. Sires, MD, PhD; Sam P. Most, MD; Arash Jian-Amadi, MD

Arch Otolaryngol Head Neck Surg. 2009;135(10):1015-1018.

Objective  To study the outcome of patients with orbital apex lesions treated with endoscopic decompression alone.

Design  Retrospective medical chart review with a mean follow-up of 25.6 months.

Setting  Departments of Ophthalmology and Otolaryngology, University of Washington, Seattle.

Patients  Five individuals seen at the University of Washington Medical Center from November 2003 through December 2005 with visual disturbance caused by orbital apex lesions as documented by preoperative magnetic resonance imaging or computed tomographic scan.

Intervention  All patients underwent endoscopic decompression of the medial wall of the orbital apex with incision of the periorbita.

Main Outcome Measures  Postoperative visual acuity, presence or absence of a relative afferent pupillary defect, color vision, and visual field were recorded.

Results  All 5 patients presented with visual field deficits, 4 of whom improved postoperatively. Three patients had dyschromatopsia preoperatively, 2 of whom improved postoperatively. Visual acuity improved or stabilized in 4 of 5 patients postoperatively. One patient had progressive visual loss during the course of her follow-up, which, after obtaining postoperative imaging, was attributed to inadequate decompression of the apex at its most posterior aspect. This same patient also developed postoperative sinusitis that resolved with antibiotic treatment. Two patients developed diplopia, 1 in primary gaze requiring treatment with prismatic lenses. All patients presented with and maintained normal intraocular pressures.

Conclusion  Orbital apex lesions can often be effectively and relatively safely treated by endoscopic decompression alone.

Author Affiliations: Departments of Ophthalmology (Drs Almond, Schiedler, Sires, and Jian-Amadi) and Otolaryngology–Head and Neck Surgery (Drs Cheng, Sires, and Most), University of Washington Medical Center, Seattle; Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California (Drs Cheng and Most); Oculoplastic and Orbital Consultants, Charlottesville, Virginia (Dr Schiedler); and Allure Medispa, Kirkland, Washington (Dr Sires).

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