EN Block Resection of Orbital Tumors

The surgical management of tumors of the optic nerve has enjoyed persistent and lively debate for many years. Some surgeons have advocated excisional biopsy of the optic nerve and tumor from posterior globe to orbital apex via a lateral orbitotomy when vision is sufficiently reduced. If the apical end of the transacted optic nerve is not tumor free, the patient requires a second, transcranial surgical procedure to eradicate the remaining tumor. Other surgeons have suggested that a one-stage removal of the optic nerve and tumor by the transcranial approach is superior to a two-stage method. Several transcranial approaches have received endorsement. Combined en bloc removal of tumor and optic nerve with nucleation of the globe has been recommended as an adjunctive management tool'. The purpose here is to review the various approaches to the management of optic nerve tumors that appear to be confined within the optic nerve sheath or that are immediately adjacent to it. Those tumors that arise within the orbital apex extrinsic to the nerve and secondarily involve it and those that enter the orbit by extension from the intracranial vault through the superior orbital fissure will not be discussed. Finally, our recommended method of dealing with optic nerve tumors will be presented.