Orbitozygomatic resection of meningiomas of the orbit.

OBJECTIVE To review our experience with the surgical treatment of orbital meningiomas. METHODS A retrospective review of all patients presenting to the author for treatment of orbital meningiomas over a 5 year period with a minimum of 1 year follow-up were included in this review. Demographic data, surgical approaches, and recurrence rates were documented. RESULTS A total of seven patients were treated for this condition. Complete surgical resection was achieved with the outlined technique in 71% of the patients, and gross tumor removal was achieved in the remaining 29% of patients. This latter group received postoperative gamma-knife treatment, and only a single patient has evidence of persistent disease that is nonprogressive at 3-year follow-up. CONCLUSIONS Meningioma of the orbit, whether primary (ectopic) or secondary. should be treated as at other sites with complete surgical excision if possible. Gamma knife or intensity modulated radiotherapy may be useful for residual microscopic disease. Surgical clearance is facilitated with the broad field exposure afforded by the orbitozygomatic approach outlined in the article, with particular attention directed at positive identification of key landmarks particularly in retro-orbital and cavernous sinus extension.