Orbital tumours are abnormal growths of tissue in the structures that surround the eye. These lesions may be either benign or malignant, and may arise primarily from the orbit or may spread from elsewhere in the body. The most common types of orbital tumours vary significantly by age, but include cysts, vascular lesions (arising from blood vessels), lymphomas, neurogenic tumours (arising from nerves) and secondary tumours (either metastatic or spread directly from the surrounding sinuses or cranium).
On occasions, these tumours may be symptom-free and patients may develop their symptoms slowly over a long period. Other patients have a very rapid onset of symptoms.
Symptoms of orbit tumours may include:
Some orbital tumours develop when a cancer in another part of the body (such as breast, lung, or prostate cancer) metastasizes (spreads) to the orbit. Melanoma (skin cancer) may also spread to the orbit. Other orbital tumours are primary, developing in the orbital socket for unknown reasons.
As with most brain tumours, imaging studies are essential to diagnosis of tumours of the orbit. Both magnetic resonance imaging (MRI) and computed tomography (CT) scans can be used. In general, MRI scans are preferred because they provide clear images of the structures within the orbit. For either study, an agent that provides contrast in the image is administered intravenously so neurosurgeons can visualize the tumour against the normal tissue in the background. In addition, a biopsy also may be conducted so the tumour tissue can be examined under a microscope to provide a definitive diagnosis.
As with most brain tumours, imaging studies are essential to diagnosis of tumours of the orbit. Both magnetic resonance imaging (MRI) and computed tomography (CT) scans can be used. In general, MRI scans are preferred because they provide clear images of the structures within the orbit. For either study, an agent that provides contrast in the image is administered intravenously so neurosurgeons can visualize the tumour against the normal tissue in the background. In addition, a biopsy also may be conducted so the tumour tissue can be examined under a microscope to provide a definitive diagnosis.
If a tumour is small and does not cause symptoms, it may be observed without treatment. If, however, the tumour causes disfiguring exophthalmos or begins to cause visual symptoms, surgical removal is the best treatment option. For benign tumours, surgery usually will provide a cure. For rare malignant tumours, surgery may be followed by radiation and chemotherapy. In addition, stereotactic radiosurgery, which involves the use of a highly focused beam of radiation to target the cancer cells, may be used as an adjunct to surgery. Surgery of orbital tumours is usually carried out by a team of neurosurgeons and neurophalmologist.
Surgery to remove an orbital tumour is complex due to its delicate location and should only be performed by highly trained neurosurgical teams with experience in the procedure. The goals of the surgery are:
In some cases, the only way to remove the tumour and protect the patient’s life is to perform an enucleation, or removal of the eye. Fortunately, this can often be avoided when surgery to remove the tumour is performed
by a highly skilled team that includes a neurosurgeon, a plastic surgeon, and an ophthalmic surgeon. When enucleation is required, a prosthetic eye can be attached to the muscles so that it moves in synch with the remaining eye,
for good cosmetic results.
The Approach
One of the difficulties in surgery for an orbital tumour is determining the approach, or the path the surgeon or surgeons will take to reach the tumour. (In major medical centers, the surgery is often performed by both a neurosurgeon
and ophthalmic surgeon working together.) Depending on the location and nature of the tumour, the surgeons may be able to approach from the side (laterally), or from above or below the eye (with incisions along the eyebrow or eyelid).
tumour Removal and Skull Reconstruction
Surgery to remove an orbital tumour may last between four and eight hours, depending on the size and complexity of the lesion. Reconstruction of the skull and/or orbit (eye socket) may be required as part of the treatment.
Additionally, acquired defects caused by trauma or benign lesions such as Graves’ disease and Paget’s disease may also require reconstructive treatment. Although the patient’s own body tissue is usually best in
any reconstruction, advances in bone and surgical technology have yielded new and exciting materials that may serve as a substitute when needed. These advances include titanium plates and screws, hydroxyapatite cement, porous polyethylene,
and resorbable fixation devices.
Surgery for Graves’ Disease
Some patients with Graves’ disease require a surgical procedure to reposition the eyelids. In more severe cases the eye itself and/or the optic nerve may require repositioning or decompression. A skilled surgeon can
make changes in the bone around the eye (orbit) that achieve excellent cosmetic and functional results.
Patients are usually hospitalized for three to seven days, and recovery time can be from two to six weeks.
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