Background: The goal of surgical resection of cranio-orbital tumors is to effectively treat the underlying pathology and correct the proptosis. This study aimed to quantitatively assess the degree of pre- and postoperative proptosis and determine the outcome of surgical resection of cranio-orbital tumors.

Methods: All cranio-orbital surgical resections causing proptosis between 2019 and 2021 were reviewed. Extent of proptosis was measured by the exophthalmos index (EI). EI was calculated as the ratio of distance of anterior limit of each globe to a line drawn between anterior limit of the zygomatic frontal processes, comparing the pathological eye to the normal one. Also, the Snellen's chart was utilized to assess vision. Postoperative radiographic measurements were assessed 3 months following surgery.

Results: A total of twenty-four patients (18 females and 6 males, with a mean age of 39.7±10.67 years) was surgically treated for proptosis associated with cranio-orbital tumors. Of them, fourteen patients harbored meningiomas, four with intraconal cavernous hemangioma, two with fibrous dysplasia, and one patient each with chondrosarcoma, histocytosis X, optic nerve glioma and osteoid osteoma. Surgical approaches included lateral orbitotomy, subfrontal, frontotemporal and modified one-piece orbitozygomatic approach. All cases of bone destruction underwent reconstruction. Preoperative EI averaged 1.87±0.38 (range 1–2.7), while the EI decreased to a mean of 1.37±0.3, postoperatively.

Conclusion: Proptosis associated with cranio-orbital pathology represents a surgical challenge. The EI is a reliable quantitative measure for assessment of proptosis. Transcranial surgery, maximal tumor removal and correction of proptosis can improve cosmetic appearance with better outcome.