Neurosurgical management of orbital inflammations and infections.

Abstract

We present an overview of the treatment and clinical outcome of 22 orbital inflammations and infections, carried out in our center from 1991 to 2002. The surgical approach was determined by the location, and type of the lesion. Lateral orbitotomy was performed in 2 laterally located lesions, a transconjunctival approach in 8 medial, basal, extra-, intraconal lesions. Pterional intradural (5), and extradural (3) approaches were used in case of intracranial involvement or location in the orbital apex and optic canal. Lesions of the lid were operated via eyebrow incision. Bacterial infections were confirmed in 5 cases (1 mucocele, 3 abscesses, 1 necrotizing inflammation). 15 patients were diagnosed as chronic inflammatory pseudotumors, 6 of whom showed a granulomatous subtype, and 3 involvement of the optic nerve. All patients failed to reveal systemic disease and had a localized orbital inflammatory process. 7 of the patients responded rapidly to systemic corticosteroid treatment with no episodes of recurrence. 3 patients showed recurrence despite corticosteroids. Orbital infections are cured by antibiotic treatment. The course of inflammatory pseudotumor is variable and requires multidisciplinary treatment. Therapeutic options include surgical biopsy or debulking, corticosteroids, chemotherapy, and radiation therapy.