Primary benign tumors of the orbital cavity: comparative data in a series of patients with optic nerve glioma, sheath meningioma, or neurinoma

BACKGROUND: Patients operated on for the most common benign pathologies of the orbital cavity-optic nerve glioma, sheath meningioma and neurinoma-should be surgically treated. However, postoperative visual impairment is frequently inevitable. A wait-and-see policy due to a slow rate of growth of these lesions is criticized. METHODS: Collecting data from three series of patients operated, we compare the surgical procedures and long-term results. RESULTS: "En bloc" removal in patients with optic nerve glioma led to complete visual deficit but ensures excellent long-term prognosis. Because optic nerve meningiomas are typically circumferential to the optic nerve and adhere tightly to the perineural pial microvascular structures, it is impossible to avoid trauma to the optic nerve and recurrences. Patients with neurinoma of the orbital cavity have the most favourable prognosis both in terms of visual function as well as long-term quality of life. Due to its slow rate of growth, a wait-and-see policy can be adopted for optic nerve glioma before deciding on surgical removal, whereas surgical treatment of meningioma may be postponed if symptoms are slight and steady. Removal of orbital cavity neurinoma should not be postponed since surgical outcome is excellent

Transsphenoidal approach to extradural midline clival chordomas

Clival chordoma, represents an aggressive tumour arising from remnants of the notochord. These tumours can create local relapses and/or metastases. The paper reports two cases of extradural midline clival chordoma operated on via transsphenoidal approaches and one case in which an assisted endoscopy was associated. In all cases the tumour involved the upper clivus. The tumour sizes ranged from 2.0 to 3.0 centimetres. The patients suffered from headache, diplopia and cranial nerve palsies. In two tumours signs of intracranial hypertension were present. In all patients, neither postoperative complications nor tumour relapses were observed at the three-year follow-up. The discussion analyzes the advantages of transsphenoidal approach with or without assisted endoscopy in the treatment of cases of extradural midline clival chordoma