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)

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)

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

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)

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

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, 19