A Team Approach to Treating Orbital Tumors (Podcast)

Schwannomas of the orbit are rare, accounting for fewer than 6% of all orbital tumors. Because schwannomas and other orbital tumors can be difficult to manage in the narrow setting of the optic canal, a multidisciplinary team approach is essential to their removal.

“In neurosurgery, dealing with issues of the skull base has historically been a largely solitary endeavor, with one surgeon taking on the challenge by him- or herself,” says Pablo Recinos, MD, a neurosurgeon in Cleveland Clinic’s Neurological Institute. “Now, we have turned the page and see that we can accomplish a lot more through a multidisciplinary approach.”

Dr. Recinos partners with Raj Sindwani, MD, a rhinologic surgeon in Cleveland Clinic’s Head & Neck Institute, and colleagues from other subspecialties to treat tumors in the orbital apex and posterior intraconal space. In the most recent episode of Cleveland Clinic’s Neuro Pathways podcast, the two surgeons discuss the diagnosis and management of orbital tumors, including:

• Clinical manifestations in patients with tumors of the orbit
• Treatment options for orbital schwannomas, meningiomas and hemangiomas
• Emerging endonasal surgical approaches
• Outcomes for patients with orbital tumors

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Sindwani: [With the endonasal approach] essentially we use the nose and sinuses, which are largely filled with air, as a corridor to get to the back of the eye. Then we gently take down the bone partitioning the nose from the eye and access the tumor through that direct line approach to the orbit.

Dr. Recinos: I would add that our experience has grown from starting with pituitary surgery … the most common procedure that we do together. However, flanked on each side of the pituitary gland are the optic nerves, and then the orbit. So these are natural areas that we work in, both for tumors that arise from the intracranial space but also now for ones that arise primarily within the back of the orbit. Working together to tackle problems in this area is a natural extension of where we have worked together in the past.

Dr. Sindwani: That’s a good point, Pablo, and the approach of having two surgeons using multiple hands, with multiple instruments going through the nose, is actually exactly the same that we use for pituitary tumors and other skull base tumors. Essentially this multi-handed technique is what allows us to safely dissect, resect and retract structures within the orbit — in this case, to then safely remove the tumor without disrupting any of the normal critical structures that are nearby.