Abstract: Objective To explore the surgical experience for orbital apex and cranio-orbital communicating neurilemoma.Methods Retrospective study of clinical manifestations, neuroradiological features and operative techniques in 22 cases underwent transcranial approach from Dec. 1997 to May. 2005. Patients ages were from 4 to 63 years, 30.6 years in average; 15 male, 7 female. Chief compliants were progressive proptosis, loss of vision in 17 patients. Radiological findings: 15 cases invading the cavernous sinus through superior orbital fissure, and 1 cases invading pterygopalatine fossa through inferior orbital fissure. Suitable transcranial approaches were choosed subfrontal craniotomy, transorbitorimal subfrontal craniotomy, transorbitorimal pterional craniotomy according to the location, size and intracranial invading of the tumor. In the orbit, the lateral approach was directed through the space between the superior and the lateral rectus muscles.Results Tumor total removal were achieved in 18 cases, subtotal removal in 3 cases, partial removal in 1 case. 1 case suffered from neurofibromatosis type 1 and pathologically confirmed orbital malignant neurilemoma. Postoperatively, ophthalmoplegia was found in 6 cases, 5 cases were recovered after 3 months respectively, permanent oculomotor nerve palsy was found in 1 case. Blindness was occurred in 2 cases. There was no operative death or other significant complication. Duration of follow up was 1 month to 7 years, tumor recurred in 1 case.Conclusion Orbital apex neurilemoma inclines invading the cavernous sinus through the superior orbital fissure. Adequate orbital apex decompression and exposure of the tumor can be reached by suitable transcranio-orbital approach. Prognosis is excellent with complete surgical excision.

Key words: neurilemoma, orbit, neurosurgical procedures