Surgical approaches to orbital tumors.

Three approaches as used with modern technology, magnification with an operating microscope, and self-retained retraction have been presented. These approaches have allowed satisfactory exposure of difficult retrobulbar orbital areas from the various directions and have allowed us to more comfortably microdissect and remove orbital tumors. They also provide good exposure for the use of the carbon dioxide laser, which has been an aid in removing the intraorbital extensions of meningiomas, plexiform neurofibromas, and difficult lymphangiomas that occupy the intraconal compartments of the orbit. These approaches should only be undertaken by a skilled ophthalmic orbital surgical team in the case of the anterior medial and lateral approach, and definitely by a well-experienced neurosurgical/ophthalmic orbital team for tumors involving the orbital cranial junction and the superior orbital compartment. Experience gained over 17 years has convinced us that a team approach is mandatory for the difficult deep intraorbital tumors, even with the anterior medial or lateral approach.