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Pacheco Callirgos G, Valentín Bravo FJ, Panadero Meseguer P, Asensio Sánchez VM. Unusual extraconal orbital location of a cavernous hemangioma. GMS OPHTHALMOLOGY CASES 2022; 12:Doc17. [PMID: 35912125 PMCID: PMC9285109 DOI: 10.3205/oc000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cavernous hemangioma is the most common benign orbital and vascular tumor in adults. It is mostly located intraconally. Nevertheless, when the location is extraconal, the displacement of the globe is opposite the tumor's position. We describe an unusual presentation of this tumor in a 75-year-old female. The only symptom was the presence of epiphora. In the clinical examination, a mass was palpated on the lower orbital rim of the right eye. The magnetic resonance imaging (MRI) showed a well-circumscribed ovoid mass with a strong T2 hyperintensity and progressive contrast filling in T1. Excisional biopsy was performed, which confirmed the diagnosis of cavernous hemangioma. At five months of follow-up, there was no evidence of new symptoms.
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Affiliation(s)
- Gabriela Pacheco Callirgos
- Hospital Clínico Universitario, Ophthalmology Department, Valladolid, Spain,*To whom correspondence should be addressed: Gabriela Pacheco Callirgos, Hospital Clínico Universitario, Ophthalmology Department, Ramón y Cajal 4, 47003 Valladolid, Spain
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Endonasal Endoscopic Approach for Minimally Invasive Orbital Decompression in Nonthyroid Proptosis-A Scoping Review. World Neurosurg 2022; 162:85-90. [PMID: 35331947 DOI: 10.1016/j.wneu.2022.03.075] [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: 01/14/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The endoscopic endonasal approach (EEA) was originally performed to treat thyroid orbitopathy and proptosis. Since then, this approach also has been used to treat other causes of proptosis. This review systematically identifies surgical outcome and complication rates in patients without thyroid proptosis who underwent endoscopic endonasal orbital decompression. METHODS Databases were searched using the following search terms: orbital disease, surgical decompression, and endoscopic endonasal approach. Two independent reviewers screened all abstracts and titles for relevance and all articles passing this screen were subjected to full-text review. To assess risk of bias, we used ROBINS-I (Risk Of Bias in Non-randomized Studies-of Interventions). RESULTS Eight studies with a total of 74 patients with nonthyroid proptosis were included. Pre- and postoperative eye examination was performed in all studies, but the extent of examination was varying. With a mean age of 35.7 years, most patients were adolescent, and most pathologies induced unilateral proptosis Complications to EEA for orbital decompression were transient diplopia (5 patients/6.8%), transient facial dysesthesia (2 patients/2.7%), ptosis (1 patient/1.4%), infarction (1 patient/1.4%), sinus obstruction (1 patient/1.4%), and enophtalmos (1 patient/1.4%). The authors reported successful reduction of proptosis in all but 2 patients (97.2%), and only 2 authors reported a need for secondary decompression. CONCLUSIONS Medial orbital decompression using EEA is a feasible approach for orbital decompression in patients with nonthyroid proptosis. While being comparable in primary outcome to transorbital approaches, the EEA seems superior in terms of complication rates.
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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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Chen L, Shen Y, Huang X, Li H, Li J, Wei R, Yang W. MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma. Front Med (Lausanne) 2021; 8:795038. [PMID: 34977096 PMCID: PMC8716692 DOI: 10.3389/fmed.2021.795038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
Aim: The purpose of this work was to develop and evaluate magnetic resonance imaging (MRI)-based radiomics for differentiation of orbital cavernous hemangioma (OCH) and orbital schwannoma (OSC). Methods: Fifty-eight patients (40 OCH and 18 OSC, confirmed pathohistologically) screened out from 216 consecutive patients who presented between 2015 and 2020 were divided into a training group (28 OCH and 12 OSC) and a validation group (12 OCH and 6 OSC). Radiomics features were extracted from T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). T-tests, the least absolute shrinkage and selection operator (LASSO), and principal components analysis (PCA) were used to select features for use in the classification models. A logistic regression (LR) model, support vector machine (SVM) model, decision tree (DT) model, and random forest (RF) model were constructed to differentiate OCH from OSC. The models were evaluated according to their accuracy and the area under the receiver operator characteristic (ROC) curve (AUC). Results: Six features from T1WI, five features from T2WI, and eight features from combined T1WI and T2WI were finally selected for building the classification models. The models using T2WI features showed superior performance on the validation data than those using T1WI features, especially the LR model and SVM model, which showed accuracy of 93% (85–100%) and 92%, respectively, The SVM model showed high accuracy of 93% (91–96%) on the combined feature group with an AUC of 98% (97–99%). The DT and RF models did not perform as well as the SVM model. Conclusion: Radiomics analysis using an SVM model achieved an accuracy of 93% for distinguishing OCH and OSC, which may be helpful for clinical diagnosis.
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Affiliation(s)
- Liang Chen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ya Shen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiao Huang
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Hua Li
- Department of Imaging, Shanghai Changzheng Hospital, Shanghai, China
| | - Jian Li
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
- *Correspondence: Ruili Wei
| | - Weihua Yang
- Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
- Weihua Yang
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Millesi M, Pichler L, Denk C, Lukas J, Matula C, Wadiura L. Clinical Outcome and Technical Nuances After Resection of Orbital Cavernous Venous Malformations-A Single-Center Experience. World Neurosurg 2021; 153:e244-e249. [PMID: 34182179 DOI: 10.1016/j.wneu.2021.06.089] [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: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cavernous venous malformations (CVMs) represent the most common benign intraorbital lesions. Enlarging or symptomatic CVMs (progressive proptosis or visual disturbances) are treated by surgical resection. For this, a variety of different surgical approaches have been described. The aim of this study was to present a contemporary series of orbital CVMs treated via open microsurgical approaches. METHODS In this study, patients who underwent resection of orbital CVMs between 2002 and 2019 were included. Presenting symptoms were noted and neuro-ophthalmologic examinations performed pre- and postoperatively. For surgical resection, the location of the orbital CVM and its relation to the orbital anatomy led to decision-making for appropriate approaches. A comparison between anatomical location and surgical outcome was performed. RESULTS Overall, 35 patients with orbital CVMs were included. Most common presenting symptoms were progressive proptosis (43%) and visual disturbances (34%). Most common location was the lateral quadrant (37%) followed by the superior quadrant (20%). A subfrontal craniotomy was performed in 40% of cases followed by a supraorbital craniotomy including the orbital rim in 34% of cases. For surgical excision, a cryo-probe was used in 30 patients, and complete resection was feasible in all cases. Location of a CVM within the superior quadrant was associated with improved postoperative recovery of visual acuity. No differences for clinical outcomes were observed depending on the surgical approach. CONCLUSIONS Resection of orbital CVMs is indicated in patients with visual disturbances or progressive proptosis. In these, microsurgical approaches can be used with minimal morbidity for complete removal of these well-circumscribed lesions.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ludwig Pichler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Denk
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Julius Lukas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Christian Matula
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
| | - Lisa Wadiura
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Richards NQ. Surgical Approaches to the Orbit: Transpalpebral. J Neurol Surg B Skull Base 2021; 82:149-153. [PMID: 33777628 DOI: 10.1055/s-0040-1722701] [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: 10/22/2022] Open
Abstract
The aim of this study is to provide an overview of the safe and effective incisional transpalpebral approaches to the orbit. The location of each approach and pertinent anatomy in each respective area, suggested approach techniques, recommended specialties, reconstruction options, intraoperative neurophysiology, complications, and approach limitations are discussed in detail.
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Affiliation(s)
- Nikisha Q Richards
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, Virginia, United States
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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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Rokohl AC, Koch KR, Kabbasch C, Kreppel M, Lüers JC, Grau S, Heindl LM. [Importance of interdisciplinary collaboration for optimal treatment of orbital tumors]. HNO 2019; 67:528-533. [PMID: 30941456 DOI: 10.1007/s00106-019-0659-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Optimal treatment of tumors with orbital invasion may exceed the competences of an individual medical specialty and require interdisciplinary cooperation. The aim of this article is to present an interdisciplinary treatment concept based on the examples of intraorbital hemangioma and squamous cell carcinoma of the paranasal sinuses infiltrating the orbit. In addition to a detailed medical history and a complete ophthalmological examination, a detailed imaging technique with standardized echography and tomography methods such as orbital thin-slice CT and/or in many cases MRI is essential for the primary classification of an intraorbital pathology. Depending on the type of pathology, a purely surgical procedure involving various disciplines such as ophthalmology, otorhinolaryngology, maxillofacial surgery, neurosurgery, and pathology, or an interdisciplinary treatment regimen including (neo)adjuvant radiotherapy or chemotherapy is necessary. Orbital tumors have a wide range of potential pathologies, requiring complex surgical procedures and multimodal therapies. In case of infiltration of the paranasal sinuses or intracranial structures, an interdisciplinary team including neuroradiologists, oral-maxillofacial surgeons, otorhinolaryngologists, neurosurgeons, radiation therapists, ophthalmologists, pathologists, oncologists, and psycho-oncologists is essential for successful treatment.
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Affiliation(s)
- A C Rokohl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - K R Koch
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - C Kabbasch
- Universitätsklinik Köln, Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Köln, Deutschland
| | - M Kreppel
- Universitätsklinik Köln, Klinik für Mund-Kiefer-Gesichtschirurgie, Universität zu Köln, Köln, Deutschland
| | - J-C Lüers
- Universitätsklinik Köln, Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln, Köln, Deutschland
| | - S Grau
- Universitätsklinik Köln, Zentrum für Neurochirurgie, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| | - L M Heindl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
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