Intact Excision of Large Extraconal Orbital Tumors Without Osteotomy: A "Hook-and-Lift" Technique.

PURPOSE: The purpose is to evaluate the safety and outcomes of a minimally invasive "hook-and-lift" technique for intact excision of large extraconal orbital tumors without the use of osteotomy.

METHODS

Retrospective review of patients with histologically confirmed solitary fibrous tumors or Schwannomas excised macroscopically intact using a "hook-and-lift" technique. Inclusion criteria were noncompressible lesions ≥25 mm in maximum dimension and/or occupying more than two-thirds of the orbit, those predominantly in the extraconal space, and those amenable to circumferential dissection.

RESULTS

Twenty patients (13 solitary fibrous tumors and 7 Schwannomas) met the inclusion criteria with 11 (55%) females presenting at a mean age of 48.2 (range, 23-78) years. Most presented with nonaxial globe displacement (90%) and reduced ocular motility (65%), while visual acuity was preserved (mean LogMAR, 0.08). The largest tumor dimension was an average of 29.3 (range, 25-40) mm, and the mean estimated volume was 6.1 (range, 1.1-15.7) mL. Depending on location, macroscopically intact without osteotomy was performed through an upper eyelid skin-crease incision (13/20), lower lid swinging flap (5/20), or retrocaruncular approach (2/20). Postoperative complications include persistent moderate ptosis (2) and motility deficit (2), including an acquired Brown syndrome; there was no impairment of vision; and no tumor recurrences were observed at a mean follow-up of 4.2 years.

CONCLUSIONS

In appropriately selected cases, the "hook-and-lift" technique provides a safe and effective method for macroscopically intact excision of large and firm extraconal orbital tumors. The technique avoids the morbidity associated with periorbital osteotomy and can yield excellent functional outcomes.