Purpose

Space-occupying lesions of the anterior skull base pose a diagnostic and surgical challenge for the oculoplasty surgeon. These cases often require a multi-team approach for excision and reconstruction, depending on the extent of the lesion.

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Methods

We present a series of 14 cases operated on between January 2024 and March 2026, under the Oculoplasty department. The clinical records, surgical videos, radiology and histopathology results, post-surgery follow-up, complications, and final results are assessed and presented here.

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Results

Out of the 14 cases operated on, 6 showed frontal sinus mucocoele (FSM) invading the orbit, 3 had orbital osteomyelitis (OOM), 2 showed orbital fibrous dysplasia (OFD), and 1 each showed diploic cavernous hemangioma of the greater wing of the sphenoid, Paget’s disease, and dystrophic calcification in response to an adjacent meningioma. Computed tomography showed definite cystic, non-enhancing osteolytic components in FSM-OOM-OFD cases, whereas the rest showed a solid bony mass. The reactive orbital bone growth in the meningioma case helped reveal an underlying mass, delineated better on magnetic resonance imaging. The patient with Paget’s disease was diagnosed conclusively with a Bone scan, which showed enhanced uptake in the affected orbital region. The surgical challenge in each case proved to be orbital reconstruction post-limited/ total removal of the primary lesion. The diploic cavernous hemangioma proved to be an extremely vascular tumor, requiring a pre-surgery embolisation of the feeder vessels, followed by a total excision. Mirroring the measurements from the contralateral side helped achieve a cosmetic appearance in all cases.

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Conclusion

Anterior skull base tumors require dedicated planning and surgical intervention, primarily involving the oculoplasty surgeons. Surgical complications are manifold and need to be anticipated preoperatively. Bony orbital reconstruction can prove to be a challenge, requiring a multi-disciplinary approach.

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Additional Authors

First name	Last name	Base Hospital / Institution
Nutan	Shah	SNEH Care, Vadodara, India

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