Ophthalmic and orbital considerations in the evaluation of skull base malignancies
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TOPIC REVIEW
Ophthalmic and orbital considerations in the evaluation of skull base malignancies Justin N. Karlin1 · Howard R. Krauss2 Received: 21 March 2020 / Accepted: 23 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system. Methods We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base. Results and conclusion Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes. Keywords Orbit · Ophthalmology · Neuro-ophthalmology · Skull base · Skull base tumor · Skull base surgery · Orbital surgery · Neurosurgical ophthalmology
Introduction Skull base malignancies can affect orbit and eye function through direct tumor extension or involvement of cranial nerves. Ophthalmologic manifestations can arise with lesions of the anterior, middle and lateral skull base (Table 1). Careful orbital and neuro-ophthalmologic evaluation is critical in the multidisciplinary care of these patients.
Orbital and ophthalmic presentations of skull base malignancies The ophthalmic or orbital manifestations of skull base malignancy may be the first to be noted by the patient; and some of these patients will inevitably present first to an ophthalmologist. Likewise, in patients with documented skull base malignancy, the ophthalmologist may be consulted to perform a baseline exam and to determine the extent of ophthalmic debilitation as a result of the tumor. These manifestations are typically related to the anatomic location of the tumor (Table 1).
Red eye * Justin N. Karlin [email protected] 1
Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, 300 Stein Plaza, Los Angeles, CA 90095, USA
Division of Neurosurgical Ophthalmology, Pacific Neuroscience Institute, 2125 Arizona Ave, Santa Monica, CA 90404, USA
2
The “red eye,” also known as conjunctival injection, is a common result of many ocular and orbital insults. Certain features may suggest involvement of intracranial structures. For instance, tortuous conjunctival and episcleral blood vessels, along wi
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