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Punukollu A, Franklin B, Pineda FG, Wouters K, Palavani L, Pan DHC, Chen HC. Gamma knife radiosurgery for orbital cavernous hemangioma: a systematic review and single-arm meta-analysis. J Neurooncol 2024:10.1007/s11060-024-04723-1. [PMID: 39075327 DOI: 10.1007/s11060-024-04723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/24/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH. METHODS In accordance with the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH. Studies reporting complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate for OCH following GKRS were included. RESULTS Six studies, out of 1856 search results, with 100 patients were included. Among them, only 5 minor complications were related to GKRS, including 3 with orbital pain and 2 with periorbital chemosis. Thus, the complication rate was 13% (95% CI, 7-25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI, 63-96%) and 71% (95% CI, 47-95%) respectively. Proptosis improved in 94% of cases (95% CI, 83-100%). The tumor reduction rate was 77% after GKRS (95% CI, 69-85%). CONCLUSION GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by an absence of a control group. Additional studies are needed to evaluate the relative efficacy of GKRS as compared with alternative surgical modalities for OCH.
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Affiliation(s)
| | | | - Felipe Gutierrez Pineda
- Department of Neurosurgery, School of Medicine, University of Antioquia, Medellin, Colombia
- Department of Neurosurgery, Colombian Neurological Institute, Medellin, Colombia
| | - Kim Wouters
- Deparment of psychologie, Open universiteit, Heerlen, Netherlands
| | - Lucca Palavani
- Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - David Hung-Chi Pan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Neuroscience, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Chung Chen
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
- TMU Research Center of Neuroscience, Taipei Medical University, Taipei, Taiwan.
- Ph.D Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan.
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2
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Wang X, Zhu B, Fu L, Tang S, Yan J. Clinical features and surgical management of traumatic acquired isolated superior rectus palsy. Eur J Ophthalmol 2024:11206721241252332. [PMID: 38706252 DOI: 10.1177/11206721241252332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
PURPOSE Isolated acquired superior rectus palsy (ASRP) is extremely rare. The goal of this report is to describe the clinical manifestations and surgical protocols for treatment of isolated traumatic ASRP. DESIGN Retrospective observational case series. METHOD Records of patients presenting with traumatic isolated ASRP from 2011 to 2020 were retrospectively reviewed. Variables analyzed included nature of the damage, ocular alignment, ocular motility, binocular vision, fundus photography, imaging and surgical treatment. RESULT Of the 23,498 strabismus surgeries performed, 16 (0.07%) were identified as being attributable to traumatic isolated ASRP. Iatrogenic injury during orbital/brain tumorectomy was the most common cause for ASRP, followed by injury resulting from a sharp object, blunt instrument, car accident, dog bite, accidental fall and explosion. The main clinical features were hypotropia and deficient supraduction of the affected eye, accompanied by exotropia, extorsion, decreased vision and ptosis. The imaging examination showed the superior orbital wall fracture in 3 cases and superior rectus rupture in 7 cases. Inferior rectus recession and/or superior rectus resection comprised the major surgical procedures employed for these cases. Vertical deviations were reduced from 45.60 ± 17.52 PD preoperatively to 12.20 ± 12.97 PD postoperatively after an average of 22.70 months at follow-up, with a success rate of 50%. CONCLUSION Traumatic isolated ASRP comprised only 0.07% of cases receiving strabismus surgery at our hospital. Orbital imaging is essential to identify whether muscle rupture, orbital fractures and/or other possible disorders are present. Superior rectus resection and inferior rectus recession represented the most frequently used surgical procedures.
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Affiliation(s)
- Xiangjun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Binbin Zhu
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Licheng Fu
- Department of Ophthalmology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Shiyu Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Jianhua Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
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3
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Abhaypal K, Singh M, Saini M, Gupta K, Gupta P. Isolated cavernous venous malformation of the eyelid. Digit J Ophthalmol 2024; 30:11-14. [PMID: 38601899 PMCID: PMC11001567 DOI: 10.5693/djo.02.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, non-infiltrative, slowly progressive vascular malformation of the orbit presenting in adults. We report the case of a 9-year-old girl who presented with a painless palpable mass over the right upper eyelid of 7 years' duration. A computed tomography scan of the orbits revealed a heterogeneously enhancing, well-circumscribed mass in the right upper eyelid with no orbital extension. A transcutaneous excisional biopsy with histopathology disclosed cavernous venous malformation. The majority of cavernous venous malformations are intraconal and present in the fourth to fifth decade of life.
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Affiliation(s)
- Khushdeep Abhaypal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Saini
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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4
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Vahdani K, Rose GE. Pupillary Abnormalities After Excision of Orbital Cavernous Venous Malformations. Ophthalmic Plast Reconstr Surg 2023; 39:40-43. [PMID: 35699206 DOI: 10.1097/iop.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS The aim of this study was to determine the incidence and recovery rate for pupillary abnormalities after excision of orbital cavernous venous malformations (OCVMs). METHODS Retrospective case-note and imaging review for patients with OCVMs, with an estimation of odds ratios (ORs) in relation to the position of the mass and surgical approach. RESULTS The 287 included patients (176 female; 61%) presented at a mean age of 46.5 years: 243/287 (85%) OCVMs were intraconal, 253/287 (88%) located in the posterior two-thirds of the orbit, and 29/287 (11%) wedged tightly in the apex. Pupillary changes-varying from minor sectoral paresis (only evident on slit-lamp examination) to a marked mydriasis-were noted in 21% (60/287) of patients and were strongly associated with removal of intraconal (60/243 [25%]; p < 0.001), apical (14/29 [48%]; OR, 4.3; p < 0.001), inferior or inferotemporal (41/105 [39%]; OR, 5.5; p < 0.001) masses. Lateral approaches-either with (23/129; 18%) or without (30/71; 42%) osteotomy-were associated with 88% (53/60) of all abnormalities (OR, 4.1; p < 0.001). Where known, the abnormalities improved in 43/50 (86%), although 15/43 (35%) had a persistent tonic pupil. CONCLUSION Pupillary abnormalities after excision of OCVMs can occur in up to a quarter of intraconal lesions-particularly those located inferotemporally or inferiorly-and in about a half of apical lesions. Lateral or inferolateral orbital approaches that disrupt the inferior intraconal fat appear to be associated with a higher risk. Most changes resolve or improve markedly, although a third of those affected may have a persistent tonic pupil.
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Affiliation(s)
- Kaveh Vahdani
- Orbital Service, Moorfields Eye Hospital, London, United Kingdom
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Yang P, Li Y, Liu HC, Qiu E, Zhang JL, Ren J, Jiang LB, Liu HG, Kang J. Prognosis Analysis and Clinical Features of Orbital Cavernous Venous Malformations With Refractory Insidious Onset. Front Oncol 2022; 11:745479. [PMID: 35178343 PMCID: PMC8844367 DOI: 10.3389/fonc.2021.745479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The present study aims to analyse the clinical presentation, treatment and prognosis of a group of patients with orbital cavernous venous malformation (OCVM) with an insidious onset. Method The clinical data of 35 patients with OCVM treated at our centre between 2003 and 2020 were retrospectively analysed. The OCVMs were classified as one of six types (I–VI) according to the orbital position of the tumour. The clinical characteristics, treatment methods and follow-up results were recorded. Results A total of 35 patients with OCVM under the optic nerve sheath in the orbital apex area or the common tendon ring (Types I and II) were included in the present study. In 20 cases (57.1%), patients were misdiagnosed with optic neuritis, and in 20 cases (57.1%), the tumour was not identified based on imaging. The presentation was acute or subacute in 23 cases (65.7%). All patients underwent surgery: transnasal surgery in 22 cases (62.9%) and craniotomy in 13 cases (37.1%). A total of 9 patients (25.7%) experienced postoperative complications, and 17 patients (48.6%) experienced vision improvement. The average patient age at first diagnosis was 43.3 ± 10.3 years, and the median follow-up period was 64.5 months. Overall, 14 patients (40%) experienced postoperative complications: postoperative blindness in 6 cases, postoperative vision loss in 8 cases and orbital apex syndrome in 7 cases. Conclusion Patients with Type I and Type II OCVMs are the most complex cases. They have an insidious onset and are associated with a high rate of misdiagnosis and missed diagnosis. Acute and subacute decreases in visual acuity are mainly caused by OCVM haemorrhage. The difficulty of surgical treatment and the poor prognosis of postoperative vision are characteristics of this tumour. Transnasal surgery and craniotomy can be used to remove OCVMs located in the common tendon ring or optic canal as well as those involving the intracranial area through the supraorbital fissure. Meanwhile, the orbital approach (orbitotomy) has proven to be an effective method of treating OCVMs not involving the deep orbital apex and intracranial area.
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Affiliation(s)
- Peng Yang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong Li
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hao-Cheng Liu
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - E Qiu
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jia-Liang Zhang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-Bin Jiang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong-Gang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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6
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Chen HC, Hu CJ, Pan DHC. Stereotactic gamma knife radiosurgery for orbital cavernous hemangioma: clinical outcome and visual function protection. J Neurooncol 2021; 152:183-193. [PMID: 33491148 DOI: 10.1007/s11060-020-03692-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Although rare, orbital cavernous hemangioma (OCH) is the most common benign orbital neoplasm in adults and may cause vision disturbance or loss due to optic nerve compression. The conventional treatment is surgical excision, which carries a risk of intraoperative nerve damage, whereas gamma knife radiosurgery (GKRS) can be a safe and effective alternative. Herein, we report the results of four patients with OCH treated with GKRS, and describe the method of treatment including the optic nerve protection. METHODS This retrospective study included four consecutive patients (three women, one man; mean age: 50 ± 14.7 years) with OCH treated with single-session GKRS between 2014 and 2020. Three patients had decreased visual acuity. During GKRS, the prescription dose delivered to the tumor margin was 12 Gy at the 55-58% isodose line. The dose to the optic nerve margin was < 12 Gy. Follow-up included sequential magnetic resonance imaging (MRI) and ophthalmological examinations at 6-month intervals. RESULTS The median follow-up period was 29.5 ± 23 months (range, 12-63 months). After GKRS, three patients with visual dysfunction had substantial vision improvement; the fourth patient continued to have normal vision without deterioration. Radiological outcomes after GKRS indicated an average tumor shrinkage of 70% ± 10.6% at the 6-month follow-up and 83% ± 2.64% at the 1-year follow-up. No adverse radiation effects were observed. CONCLUSIONS GKRS for OCH achieved favorable clinical outcomes, with substantial tumor volume reduction. OCH can be diagnosed based on characteristic MRI findings. GKRS may be considered a treatment option for OCH in selected cases.
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Affiliation(s)
- Hsien-Chung Chen
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. .,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
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7
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Chaoui Roqai Y, Aachak M, Malek Y, El Khoyaali A, Mouzari Y, El Asri F, Reda K, Oubaaz A. [Bleeding from an orbital cavernous hemangioma: A rare presentation]. J Fr Ophtalmol 2020; 44:e111-e113. [PMID: 33187738 DOI: 10.1016/j.jfo.2020.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Y Chaoui Roqai
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc.
| | - M Aachak
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - Y Malek
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - A El Khoyaali
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - Y Mouzari
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - F El Asri
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, avenue des FAR, Hay Ryad, 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc
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8
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Bagheri A, Feizi M, Tavakoli M. Unusual Subcutaneous Presentation of Cavernous Hemangioma in the Lower Eyelid. J Ophthalmic Vis Res 2020; 15:236-239. [PMID: 32308958 PMCID: PMC7151512 DOI: 10.18502/jovr.v15i2.6741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a patient with cavernous hemangioma (CH) presenting as a "subcutaneous" lower eyelid mass. Case report A 37-year-old man presented with a painless and palpable mass over the right lower eyelid for two years prior to referral. Computed tomography scan revealed a well-defined, lobulated mass located in the mid and lateral portion of the lower eyelid that extended posteriorly to the anterior orbital space. A transcutaneous excisional biopsy was performed. Histopathologic findings of the tumor confirmed CH. Most CHs are intraconal lesions, making our case an unusual presentation for this condition. Conclusion Purpose Case report CH may present superficially in the eyelid and anterior orbital area and thus, although this location is not common, it should be kept in mind as a differential diagnosis for any well-defined eyelid tumor.
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Affiliation(s)
- Abbas Bagheri
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, The University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, Al, USA
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Dzhindzhikhadze RS, Dreval' ON, Lazarev VA, Polyakov AV. [The transpalpebral keyhole approach in surgery of orbital cavernomas: a case report and literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:73-80. [PMID: 29927428 DOI: 10.17116/neiro201882373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Currently, there are many different surgical approaches to orbital pathology. This pathology rarely occurs in neurosurgical practice, and neurosurgeons have often used approaches that can be accompanied by negative cosmetic and functional outcomes. MATERIAL AND METHODS We present a case report of orbital cavernoma removal via a minimally invasive approach. RESULTS The presented case demonstrates successful removal of orbital cavernoma using the transpalpebral approach: a skin incision along a natural fold of the upper eyelid and orbitofrontal keyhole craniotomy. In the postoperative period, existing symptoms regressed; the patient assessed the cosmetic effect as excellent. CONCLUSION The transpalpebral keyhole approach can be an excellent alternative to traditional approaches to orbital cavernomas. This approach demonstrated its efficacy and safety in skull base surgery and provided excellent functional and cosmetic outcomes.
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Affiliation(s)
- R S Dzhindzhikhadze
- Russian Medical Academy of Postgraduate Education, Barrikadnaya Str., 2/1, Bldg. 1, Moscow, Russia, 125993
| | - O N Dreval'
- Russian Medical Academy of Postgraduate Education, Barrikadnaya Str., 2/1, Bldg. 1, Moscow, Russia, 125993
| | - V A Lazarev
- Russian Medical Academy of Postgraduate Education, Barrikadnaya Str., 2/1, Bldg. 1, Moscow, Russia, 125993
| | - A V Polyakov
- Inozemtsev City Clinical Hospital, Fortunatovskaya Str., 1, Moscow, Russia, 105187
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Shchurova IN, Pronin IN, Mel'nikova-Pitskhelauri TV, Serova NK, Grigor'eva NN, Fadeeva LM, Shishkina LV. [Orbital hemangiomas: capabilities of modern neuroradiological diagnostics]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:57-69. [PMID: 30137039 DOI: 10.17116/neiro201882457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
MATERIAL AND METHODS In the period from 2010 to 2016. 14 patients with cavernous hemangioma (CH) and 2 patients with capillary hemangioma (CapH) of the orbit were examined. The age of CH patients varied from 17 to 67 years (median, 53 years); 8 females and 6 males. The age of CapH patients was 35 and 54 years. All patients underwent surgery with subsequent histological verification. CT-perfusion was performed in 10 CH patients and 2 CapH patients according to a developed low-dose protocol (80 kV, 200 mAs, tscan=40 s) with allowance for a target localizer (80 kV, 120 mAs) and at a maximum radiation dose of not more than 4.0 mZv. Neoplasm microcirculation was quantitatively assessed by calculating hemodynamic parameters: blood flow velocity (BFV), blood volume (BV), and mean transit time (MTT). MRI without and with contrast enhancement was performed in 11 CH patients and 2 CapH patients according to the ophthalmologic protocol (Signa GE, 3.0 T) accepted at the Institute: without contrast enhancement - T1, T2, and T2-FLAIR modes, T1 and T2 with a Fat Sat technique at a scan thickness of 3 mm, and DWI MRI; contrast enhancement - T1 (three projections) mode, including the Fat Sat technique. SWAN (n=2) and non-contrast MR perfusion ASL (n=3) were also used. Diffusion-weighted images (DWI) were processed with calculation of the apparent diffusion coefficient (ACD). RESULTS In all CH patients, CT-perfusion revealed low perfusion parameters of blood flow: BVCH=0.86±0.37 mL/100 g, BFVCH= 4.89±2.01 mL/100 g/min with a high mean transit time MTTCH=10.13±3.05 s compared to the same parameters of blood flow in the normal white matter: CBVNormWM=1.63±2.22 mL/100 g, CBFVNormWM=9.72±3.13 mL/100 g/min, and MTTNormWM=6.76±2.78 s. In CapH cases, significantly increased blood flow velocity and volume values and a low MTT value in the tumor were observed: BVCapH=10.30±4.10 mL/100 g, BFVCapH=119.72±53.13 mL/100 g/min, and MTTCapH=4.35±1.79 s. In the case of orbital hemangiomas, optimal MRI modes were T1 and T2 with the Fat Sat technique, a scan thickness of 3 mm, and intravenous contrast enhancement. The revealed pattern of contrast agent accumulation by CH, initially in the central part and then in the periphery, may be a useful radiographic sign in the differential diagnosis with other orbital tumors. CONCLUSION Modern CT- and MRI-based diagnostics of orbital hemangiomas provides not only the exact location, size, and spread of the lesion but also reveals the characteristic structural features of these tumors, and the use of perfusion techniques visualizes hemodynamics of the tumors. CT-perfusion-based hemodynamic parameters of cavernous hemangiomas typical of this type of hemangiomas may be used in the differential diagnosis with other tumors of this location. The use of contrast enhancement and the Fat Sat technique with a scan thickness of not more than 3 mm is optimal for MRI diagnostics of orbital hemangiomas.
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Affiliation(s)
| | - I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - N K Serova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
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12
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Calandriello L, Grimaldi G, Petrone G, Rigante M, Petroni S, Riso M, Savino G. Cavernous venous malformation (cavernous hemangioma) of the orbit: Current concepts and a review of the literature. Surv Ophthalmol 2017; 62:393-403. [PMID: 28131871 DOI: 10.1016/j.survophthal.2017.01.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
The cavernous venous malformation of the orbit, previously called cavernous hemangioma, is the most common primary orbital lesion of adults. Cavernous venous malformation occurs more often in women and typically presents in the fourth and fifth decades of life. It is a benign vascular malformation characterized by a well-defined capsule and numerous large vascular channels. The most common sign of cavernous venous malformation is progressive axial proptosis from the preferential involvement of the intraconal orbital space. Optic nerve damage and other signs of orbital pathology may be present, with a variable degree of visual impairment. The combination of ultrasound, computed tomography, and magnetic resonance imaging leads to an accurate diagnosis in the vast majority of cases. Surgical and nonsurgical treatments are required in case of symptomatic lesions, with a characteristic multidisciplinary management influencing optimal outcome. Orbitotomy represents the traditional surgical approach. Recently, the endoscopic transnasal approach to the orbital cavity has gained interest, representing a feasible and safe, less-invasive surgical technique for the management of cavernous venous malformation.
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Affiliation(s)
- Luigi Calandriello
- Department of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy; Ophthalmology, Fondazione G. B. Bietti-IRCCS, Rome, Italy
| | - Gabriela Grimaldi
- Department of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluigi Petrone
- Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Rigante
- Department of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Petroni
- Department of Pediatrics, Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Monica Riso
- Department of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gustavo Savino
- Department of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy.
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13
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[Surgical approaches of tumors of the posterior cone of the orbit]. ACTA ACUST UNITED AC 2016; 117:89-95. [PMID: 26928476 DOI: 10.1016/j.revsto.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/24/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
The surgical management of posterior orbital tumors is complex because it is an anatomical area located at the borders between the face and the skull base. The goal of the procedures carried-out in this area is to resect the tumor while preserving vision by using the safest possible approach. The aim of our work was to determine, in the light of our experience and of a review of the literature, the advantages and drawbacks of the numerous approaches described.
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