Cranio-orbital Minicraniotomy for Orbital Lesions: Surgical Experience of 28 Patients

Objective: The cranio-orbital minicraniotomy is a modification of the subfrontal approach with orbital osteotomy. The purpose of this study is to describe the technique of this approach and evaluate the outcome in 28 consecutive patients suffering from various orbital lesions. Methods: This is a retrospective study carried out on 28 patients having different orbital lesions. All the patients were operated upon by cranio-orbital minicraniotomy through eyebrow skin incision and a small craniotomy measured 2.5cm height and 3.5cm width with added orbital osteotomy. All the patients were evaluated for the degree of surgical excision and outcome. Results: A cranio-orbital minicraniotomy was used to treat 28 orbital lesions over a period of 8.5 years. The mean age of the patients was 29.5 years (range 2–66 years). They were 16 women and 12 men. This series includes periorbital meningioma in seven patients (25%), cavernous hemangioma in six patients (21.4%), orbital abscesses in four patients (14.3 %), neurofibroma in three patients (10.7%), depressed fracture of the orbital roof in three patients (10.7 %), depressed fracture of the lateral orbital wall in two patients (7.1%), dermoid cyst, epidermoid cyst and optic nerve glioma in one patient for each diagnosis (3.6%). Total removal was achieved in 12 patients: six patients with cavernous hemangiomas, three patients with periorbital meningiomas, and one patient with dermoid, epidermoid and neurofibroma respectively. Partial excision of the lesions was obtained in six patients: four patients with periorbital meningiomas and two patients with neurofibromas. Biopsy was taken in one patient of optic nerve glioma. Evacuation of an orbital abscess was achieved in four patients. Correction of depressed bone with correction of bone defect was done effectively in five patients. Conclusion: Despite the small size of craniotomy and skin incision, the cranio-orbital minicraniotomy allowed enough room for intra-orbital manipulation and excision of different orbital lesions. Microsurgery with cranio-orbital minicraniotomy is a safe and effective method for treatment of patients having orbital lesions.