Comparison of Transcranial and Extracranial Surgical Approaches For Orbital Lesions

Objective:  The objective of the study was to compare the utilization and results of various surgical procedures for the orbital and paraorbital lesions. Neurosurgeons are confronted to orbital pathologies, when either intracranial lesion extended into orbit or when a symptomatic orbital lesion is not confined to orbit. A wide variety of surgical approaches can be utilized to deal with lesions of orbit. Study Design:  Retrospective study. Material and Methods:  A study was conducted at Lahore General Hospital, Lahore to evaluate the operative results regarding the resectability and functional outcome, as well as to assess the advantages of various surgical approaches. This is a retrospective study with a study period of 10 years from Nov 1993 to Nov 2003. Results:  Forty cases were included in the study. Mostly patients were operated by transcranial approaches like Frontoorbital craniotomy 23 (57.5%), Frontal craniotomy with superior will orbitotomy 6 (15%) cases, Bifrontal craniotomy 2 (5%) case and Fronto-orbitozygomatic approach (OZA) 2 (5%) cases. Thus out of 40 cases 33 (82.5%) cases were operated by transcranial approaches. Extracranial approaches were utilized in 6 cases, most common approach was suprolateral orbitotomy 5 (12.5%), transethmoidal approach 1 (2.5%) case and anterior exenteration 1 (2.5%) case. Post operative recovery was excellent in 35 (87.5%), good in 3 (7.5%) and fair in 2 (5%) cases. All had excellent functional outcome. Complete resectability was possible, in 38 (95%) patients. Proper planning and selection of approach pave the way for successful excision and excellent outcome. &nbsp