Craniofacial Resection For Orbital Tumours - Results Of A Multidisciplinary Surgical Approach.

INTRODUCTION- Orbital tumours comprise a rare and heterogenous group of tumors. The complex anatomy of orbit poses a challenge to surgical resection and reconstruction. A subset of patients with advanced orbital tumours require craniofacial resection. Craniofacial resection using a multidisciplinary approach offers the advantage of optimal oncologic and functional outcomes. We performed an audit of our experience with orbital tumours requiring craniofacial resections and present the outcomes. MATERIALS and METHODSA prospectively maintained database in the Department of Surgical Oncology, BRA IRCH, AIIMS, New Delhi from 2012 to 2017 was accessed and all patients undergoing craniofacial resection for orbital tumors were analysed. A two team multidisciplinary surgical approach involving Surgical oncology and neurosurgery was adopted in all cases. RESULTS- A total of 5 out of 31 patients undergoing orbital exenteration for orbital tumours required craniofacial resection. Mean age of presentation was 53years (18 - 69) with a male preponderance ( M:F= 3:2). The tumours were of varied histopathologic sub-types- Adenoid cystic carcinoma, Pleomorphic adenoma, mesenchymal Chondrosarcoma, Apocrine carcinoma, sebaceous cell carcinoma. Four out of 5 patients presented with recurrent/ residual disease after a prior sub-optimal surgical intervention. Craniofacial resection was performed by trans-facial followed by trans-cranial approach in 4 patients and in 2 patients dura was resected. R-0 resection could be achieved in all patients with no significant post operative morbidity. Temporalis muscle flap was used in all patients for soft tissue reconstruction and in 2 patients each titanium mesh and cranioplasty using calvarial graft was used. Four patients received adjuvant radiotherapy. One patient relapsed and four patients were disease free at last follow-up. CONCLUSION-A subset of orbital tumours with varied histologies can present with intracranial extension creating challenges in management. A multidisciplinary aggressive surgical approach for resection and expertise for soft tissue and rigid reconstruction is necessary for optimal outcomes. [ABSTRACT FROM AUTHOR]