Combined cranio-orbital surgery for extensive malignant neoplasms of the orbit.

Extensive, invasive neoplasms of the cranio-orbital region are generally considered to be inoperable and are treated with local radiation therapy and occasionally with chemotherapy. Upon local recurrence of these neoplasms, further treatment efforts are usually deemed futile. Over the past 4 years, 10 patients with extensive neoplasms of the cranio-orbital region that were previously thought to be inoperable were referred to us for further evaluation. Five of these patients had failed an intensive course of radiation therapy. Radical regional cranio-orbital resection was performed. The resection included the skin, globe, sphenoid wings, and orbitofrontal bone. The maxillary sinus and nasal septum were left exposed. The exposed dura mater and the frontal and temporal bones were resurfaced with split-thickness skin grafts. All patients in this series have survived free of local disease to date. Combined cranio-orbital resection offers both palliation and a possible cure for patients with extensive, invasive neoplasms of the cranio-orbital region. Reconstructive surgery can be performed using full-thickness flaps after 2 years of observation for local recurrence.