What Are the Tips on Surgery for Orbital Apex Lesion?

The orbital apex is surrounding by the bony structure. So, if the lesion appears, it is easy to cause the visual disturbance. In this paper, I focus on the anatomical and clinical specificity of the orbital apex, and clarify the tips on surgery.

Materials and Methods: We reviewed surgical cases of primary orbital tumors and selected the cases which had the lesion in the orbital apex. Among 102 cases, eight had the lesion around the orbital apex. We studied the tumor size, pathology, tumor location, surgical approach, and pre-/postoperative visual acuity.

Results and Discussion: All cases were treated by the transcranial approach. The annulus tendon was opened at the oculomotor foramen based on the anatomical understanding. There was no relation between the severity of the symptoms and the tumor size. Postoperatively, most of all cases had recovered visual acuity except the cases that are less than light sensation, preoperatively. It is quite rare to cause the visual disturbance by the small intraorbital lesion. But the apical located small lesion may cause the visual disturbance in acute course. The opening of the annulus tendon in early stage of the operation was the key factor of the preservation of the visual acuity.