Management of the orbit during anterior fossa craniofacial resection

Objective: To determine the postoperative ocular function in patients undergoing anterior fossa craniofacial resection with preservation of the orbit. Design: Retrospective medical chart review of patients treated from January 1, 1973, to July 31, 1994. Median follow-up was 38 months (range, 1- 210 months). Selling: Tertiary referral center. Patients: Fifty-eight consecutive patients undergoing anterior fossa craniofacial resection with orbital preservation for tumors involving the anterior skull base. Main Outcome Measures: Assessment of orbital complications of treatment, need for further surgical intervention to correct these complications, and determination whether functional vision was retained at last follow-up examination, and tumor recurrence within preserved orbits. Interventions: Anterior craniofacial resection with orbital preservation. Postoperative radiation therapy was administered to selected patients. Results: Overall, 25 patients (43%) had some ocular sequelae of their treatment. This consisted of epiphora in 21 patients, diplopia in 8, vision loss in 6, and pain and enophthalmos in 2. Twelve patients required revision surgery consisting of dacryocystorhinostomy in 8, ectropion repair in 3, drainage of orbital mucocele in 1, and corneal transplant in 1. Ocular complications were more common and vision loss occurred only in patients treated with postoperative radiation therapy. Functional vision in the ipsilateral eye was retained in 50 of the 58 patients. Conclusions: When the orbit is preserved during anterior fossa craniofacial resection, ocular sequelae are frequent and may require revision surgery. Functional vision can be preserved in most patients.