Combined transcranial-orbital approach for resection of optic nerve gliomas: a clinical and anatomical study

Ophthalmic Plast Reconstr Surg. 2012 May-Jun;28(3):184-91. doi: 10.1097/IOP.0b013e3182232395.

Abstract

Purpose: To describe a combined transcranial-orbital approach for en bloc resection of optic nerve gliomas with preservation of the annulus of Zinn that minimizes recurrence and prevents postoperative paralytic ptosis.

Design: A retrospective, noncomparative, interventional case series.

Study population: All patients who underwent optic nerve glioma resections using this technique with the authors between 1994 and 2010.

Procedure: A transcranial-orbital approach is used to resect the intracranial segment of the optic nerve glioma from 2 mm anterior to the chiasm to the posterior extent of annulus of Zinn. The proximal transected edge of the nerve is examined intraoperatively for tumor margin clearance. Through a superior orbitotomy exposure, the entire retrobulbar segment of the tumor is transected from the globe to the annulus of Zinn. A simulation of the procedure in a cadaver and en bloc resection of the orbital apex are performed to demonstrate the subdural plane of dissection within the annulus of Zinn.

Main outcome measures: Postoperative outcome measures include: health of the ipsilateral globe, paralytic ptosis, postoperative complications, and tumor recurrence.

Results: Eleven patients underwent resection of optic nerve gliomas using this technique. No patients had tumor recurrence or developed postoperative paralytic ptosis.

Conclusions: The combined transcranial-orbital approach with preservation of the annulus of Zinn is a safe and effective way to remove optic nerve gliomas and ensure tumor clearance while avoiding paralytic ptosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Craniotomy*
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Recurrence, Local
  • Ophthalmologic Surgical Procedures*
  • Optic Nerve Glioma / diagnosis
  • Optic Nerve Glioma / surgery*
  • Optic Nerve Neoplasms / diagnosis
  • Optic Nerve Neoplasms / surgery*
  • Orbit / surgery*
  • Postoperative Complications
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Visual Acuity / physiology
  • Young Adult