ORBITAL
TUMOR
SURGERY

With a combined experience of over 30 years, Dr. Joseph C. Maroon and Dr. John S. Kennerdell have been recognized as world leaders in the surgical treatment of orbital tumors. Having presented at numerous national and international neurosurgical and ophthalmologic conferences and having contributed over 17 book chapters and many articles to the medical literature, Dr. Maroon and Dr. Kennerdell are routinely asked to treat the most difficult orbital tumors. Through their many years of experience and many hours in the anatomy lab they have developed and perfected many of the modern surgical techniques used to treat orbital tumors.

Drs. Maroon and Kennerdell have routinely treat orbital tumors referred from physicians from all over the world. State-of-the-art equipment and diagnostic tools are used to diagnosis and treat tumors of the orbits and brain.

This page is to be used as a source for information on orbital tumors for both medical professionals and patients. A listing of the many book chapters and articles will appear below and those highlighted will have a copy of the article's abstract. Most medical libraries will have the complete articles. 

If you wish to be evaluated or would like a second opinion, please call 888-234-4357, and our staff will instruct you on how to arrange an evaluation and what X-rays will need to be forwarded.

Please return to this page frequently to find the latest article or announcement for conferences that Drs. Maroon and Kennerdell will be speaking on orbital tumors.

  See Discharge Instructions following Craniotomy

Articles and Book Chapters listed in chronological order:

Articles:
Maroon, J.C., Kennerdell, etal; Comments to the Editor, "Successful Surgical Treatment of Intraorbital AVM: Case Report", by Hieu, etal: Neurosurgery, 40(3), pp 631, Mar 1997

Maroon, J.C., Kennerdell; "Surgical Approaches to Tumors of the Orbit", Proceedings of the Japanese Congress of Neurological Surgeons, Neurosurgeons 16 pp. 231-238, 1997

J.C.Maroon, et al: Recurrent spheno-orbital meningioma. J Neurosurg 80: 202-208, 1994.

J.C.Maroon, et al: Cryosurgery re-visited for the removal and destruction of brain, spinal and orbital tumors. Neurological Research 14: 294-302, 1992.

Kazim, M., Kennerdell, J.S.,etal: "Orbital Lymphangioma", Ophthalmology 99: 1588-1594, 1992

John S. Kennerdell, et al: Use of the Carbon Dioxide Laser in the Management of Orbital Plexiform Neurofibromas. Ophthalmic Surgery Vol 21, No. 2: 138-140, 1990.

John S. Kennerdell, et al: Surgical Management of Orbital Lymphangioma With the Carbon Dioxide Laser. American J Ophthalmology 102: 308-314, 1986.

J.C. Maroon, et al: Surgical Approaches to the Orbit. Contemporary Neurosurgery Vol. 6, No. 1: 1-6, 1984.

Patrick A. Sibony, et al: Optic Nerve Sheath Meningiomas. Ophthalmology, Vol. 91, No. 11: 1313-1326, 1984.

J.C. Maroon, et al: Surgical approaches to the orbit. J Neurosurg 60: 1226-1235, 1984.

Louis E. Mark, et al: Microsurgical Removal of a Primary Intraorbital Meningioma. American J Ophthalmology 86: 704-709, 1978.

John S. Kennerdell, et al: Microsurgical Approach to Intraorbital Tumors. Achives of Ophthalmology Vol. 94: 1333-1336, 1976.

J.C. Maroon, et al: Lateral microsurgical approach to intraorbital tumors. J Neurosurg Vol. 44, No. 5: 556-561, 1976.

Recurrent spheno-orbital meningioma

JOSEPH C. MAROON, M.D.9 JOHN S. KENNERDELI,G M.D.9 DANKO V. VIDOVICH M.D., ADNAN ABLA, M.D., AND LINDA STERNAU, M.D.

A series of 15 patients who underwent neurosurgical procedures for recurrent spheno-orbital meningioma is reported. There were I I women and four men, with a mean age of 46 years. The mean duration between the first and second operations was 46 months. Progressive proptosis without neurological deficit was the most common symptom. All tumors were large at the time of reoperation and involved the greater and lesser wings of the sphenoid bone and the orbit. Aggressive resection in all patients resulted in no deaths and only slight morbidity, with the exception of one patient who developed blindness 24 hours after surgery due to central retinal artery occlusion. Fourteen patients were improved cosmetically and one patient, treated early in the series, had persistent proptosis due to inadequate bone removal. No attempt was made to remove tumor within the cavernous sinus in patients who were neurologically normal. Although postoperative imaging demonstrated complete gross excision of tumor in nine patients, 10 underwent conventional radiation therapy for residual tumor visualized at the time of surgery in the dura of the superior orbital fissure, the cavernous sinus, or the basal optic canal. Although this study is inconclusive and requires further long-term documentation, no recurrences have been seen to date in the follow-up period, ranging from 16 to 95 months. The following important points are discussed: 1)the failure by experienced surgeons to radically excise bone, tumor, and involved dura at the first operation. 2)the importance of early aggressive therapy, depending upon the patient's age and medical condition; 3) the almost invariable intracranial dural involvement, which at times was seen only by gadolinium-enhanced magnetic resonance imaging and not visualized on computerized tomography; 4) an illustrated stepwise surgical technique for complete resection through a small craniotomy without the need for complicated reconstruction of the orbit or temporal fossa; 5) the role of radiation therapy when removal is incomplete or deemed hazardous because of cavernous sinus involvement; and 6) the excellent cosmetic results possible with minimal morbidity and no mortality. (J Neurosurg 80: 202-208, 1994)

Cryosurgery revisited for the removal and destruction of brain, spinal and orbital tumors

Joseph C. Maroon, Gary Onik, Matthew R. Quigley, Julian E. Bailes, Jack E. Wilberger and John S. Kennerdell

Advances in neuroimaging and cryosurgical techniques have prompted us to re-evaluate the potential of cryosurgical techniques for the removal and the destruction of various neoplasms. We have used cryosurgical instrumentation to remove tumors in the brain, spine and orbit in 71 patients without complications. Cryosurgery was used to facilitate removal and extraction in 64 and to destroy residual neoplasms when removal was incomplete in 7. lntraoperative real time ultrasonic imaging permitted precise delimitation of tumors from surrounding tissues and allowed monitoring during the production of cryosurgical lesions thus permitting heretofore unavailable visualization of the production of cryogenic lesions in the central nervous system. New cryosurgical instrumentation was used to produce lesions up to three times larger than similar sized probes previously available. Our results reconfirm that cryosurgery facilitates the removal of tumors in the brain, spinal cord and orbit, reduces blood loss in vascular tumors, and is effective in ablating residual neoplasms involving the superior saggital sinus, torcula and parasaggital areas. A Doppler flowmeter proved useful for monitoring saggital sinus blood flow during the production of cryosurgical ablation of residual tumor attached to the walls of the saggital sinus. Recent advances in ultrasonic and neuroimaging coupled with stereotactic techniques and improvements in cryosurgical instrumentation may prove useful in the future percutaneous destruction of selective intracranial neoplasms. [Neurol Res 1992; 14: 294-302]

Use of the Carbon Dioxide Laser in the Management of Orbital Plexiform Neurofibromas

John S. Kennerdell, MD, Joseph C. Maroon, MD

ABSTRACT We present one of three cases in which we have used the carbon dioxide laser to successfully perform subtotal surgical removal of plexiform neurofibromas of the lid and orbit. (Ophthalmic Surgery Vol 21, No. 2: 138-140, 1990)

Surgical Management of Orbital Lymphangioma With the Carbon Dioxide Laser

John S. Kennerdell, M.D., Joseph C. Maroon, M.D., James A. Garrity, M.D., and Adnan A. Abla, M.D.

Lymphangiomas of the ocular adnexa, especially those in the orbit, are difficult to treat because the unencapsulated tumor freely interdigitates with normal orbital tissue, obliterating any potential surgical plane. Because of the hemorrhagic and friable nature of the tumor, conventional surgical techniques are frequently complicated by bleeding. We used the C02 laser to remove these lesions subtotally by controlled vaporization in six patients (four girls and two boys, 5 to 17 years old). Three pupils remained dilated postoperatively because of damage to the ciliary nerves and symblepharon formation occurred in one case. None of these has produced any symptoms. In one case, however, laser treatment may have produced corneal anesthesia. (American J Ophthalmology 102: 308-314, 1986)

Optic Nerve Sheath Meningiomas Clinical Manifestations

PATRICK A. SIBONY, MD, HOWARD R. KRAUSS, MD, JOHN S. KENNERDELL, MD, JOSEPH C. MAROON, MD, THOMAS L. SLAMOVITS, MD

Abstract: A retrospective clinical study of optic nerve sheath meningiomas based on 22 patients showed that symptoms most commonly develop in women between the ages of 35 and 60 years. The most common presenting symptoms were decreased vision and transient visual obscurations. In the earliest stages, many patients presented with normal to mildly impaired acuity (despite subjectively decreased vision), optic disc edema and enlargement of the blind spot. Optic disc edema was frequently associated with retractile bodies indicative of chronic swelling. Optic disc edema preceded the development of optic atrophy. Another group of patients presented with a history of longstanding vision loss, visual acuity of 20/200 or worse and optic atrophy. Optociliary shunt vessels were late findings only seen in five patients. The most consistent visual field abnormality was peripheral constriction. Cecocentral scotomas were uncommon. Intracranial involvement was present in five patients. There were two patients with bilateral optic nerve sheath meningiomas without CT evidence of intracranial involvement. Computerized tomography was found to be indispensable in the diagnosis of optic nerve sheath meningiomas and the detection of intracranial involvement. Ophthalmology 91:1313-1326, 1984

Surgical approaches to the orbit Indications and techniques

JOSEPH C. MAROON, M.D., AND JOHN S. KENNERDELL, M.D.

The authors review their experience with over 300 patients with orbital tumors, and summarize their surgical techniques and indications for each surgical approach. A fronto-orbital approach is described which is used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral micro-orbitotomy is used for tumors located in the superior, temporal, or inferior compartment of the orbit and those in the lateral apex. A medial microsurgical approach is used for tumors located medial to the optic nerve but not deep in the apex. By thus approaching tumors directly, optimal exposure is obtained and functional deficits are minimized. The pertinent surgical anatomy is illustrated and the technique of fine-needle aspiration biopsy is discussed. (J Neurosurg 60: 1226-1235, 1984)

MICROSURGICAL REMOVAL OF A PRIMARY INTRAORBITAL MENINGIOMA

Louis E. MARK, MD., JOHN S. KENNERDELL, M.D., JOSEPH C. MAROON, M.D., ARTHUR E. ROSENBAUM, M.D., RALPH HELNZ, MD., AND BRUCE L. JOHINSON, M.D.

The well-known prognosis for meningiomas of the orbit or cranio-orbital junction is visual loss. We recently removed a primary intraorbital optic nerve sheath meningioma in a patient whose visual acuity was finger counting for about six months. Although the tumor encircled the nerve, only mild optic atrophy was present. Postoperatively, visual recovery was almost complete, which was undoubtedly related to a fine balance having been maintained between the compressive force of the tumor and the vascular supply to the nerve. To our knowledge, this is the first report of visual recovery following microsurgical orbital dissection for this type of tumor. (American J Ophthalmology 86: 704-709, 1978)

Microsurgical Approach to Intraorbital Tumors Technique and Instrumentation
John S. Kennerdell, MD, Joseph C. Maroon, MD
We believe that, with the modified Kronlein lateral orbitotomy microsurgical approach, most orbital tumors can be successfully removed with reduced morbidity and complications, compared with the frontotemporal craniotomy or the standard Kr6nlein lateral orbitotomy. The cosmetic result is quite satisfactory, and the hospital stay should be brief. The use of the operating microscope and the specifically designed and modified instruments for retraction and dissection in the orbit, combined with the efficiency of the self-irrigating bipolar coagulating forceps, add a new dimension to the safety and efficiency of orbital surgery. (Arch Ophthalmol 94:1333-1336, 1976)

Lateral microsurgical approach to intraorbital tumors

JOSEPH C. MAROON, M.D., AND JOHN S. KENNERDELL, M.D.

The authors describe their microsurgical lateral orbital approach to intraorbital tumors. In seven patients ultrasonic scanning, computerized axial tomography, polytomography, orbital venography, and arteriography have allowed precise intraorbital tumor localization relative to the optic nerve. The authors believe that circumscribed tumors superior, lateral, or inferior to the optic nerve can be safely and completely removed through a 30-35-mm lateral skin incision with microsurgical dissecting techniques. A combined neurosurgical-ophthalmological team approach is emphasized. (J Neurosurg Vol. 44, No. 5: 556-561, 1976)

Homepage, Physicians, Specialties, Hospitals, Offices, Insurance, Appointments, E-Mail

Disclaimer:

Every effort has been made by the author (s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor UPMC shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material.

CLINICAL DISCLAIMER:

Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

For questions or comments, please contact: bostj@msx.upmc.edu

 

© 2008 Tri-State Neurosurgical Associates - UPMC

Last Updated: January 1, 2008