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Jinhai Y, Zexi S, Gang H, Yaohua W, Hongfei L. Two cavernous hemangiomas masquerading as single space occupying tumors in the orbital apex were removed under nasal endoscope: A case report. Int J Surg Case Rep 2024; 115:109283. [PMID: 38290358 PMCID: PMC10840356 DOI: 10.1016/j.ijscr.2024.109283] [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: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE This report details the unusual presentation of two hidden cavernous hemangiomas in the orbital apex, initially appearing as one tumor. The rarity and diagnostic complexity of this case underscore the need for meticulous surgical exploration and verification in orbital apex tumors. CASE PRESENTATION A physical examination of an elderly male with a three-year history of headaches revealed a space-occupying lesion in the left orbital apex. Imaging confirmed a tumor in the extraconical space above the optic nerve. Initial nasal endoscopy removed an orbital apex tumor, pathologically confirmed as a cavernous hemangioma. CLINICAL DISCUSSION Postoperative examination revealed incomplete tumor removal, prompting a second surgery for full excision. This case underscores the diagnostic and management challenges of orbital apex tumors, especially when imaging indicates a single mass. The endoscopic transsphenoidal approach for cavernous hemangiomas in the medial orbital apex, as illustrated in this case, appears promising. CONCLUSION Clinicians must be aware of the potential for multiple tumors in orbital apex cases, even if imaging does not explicitly reveal them. This case highlights the importance of thorough surgical exploration and illustrates the effectiveness of endoscopic methods in intricate orbital apex surgeries.
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Affiliation(s)
- Yu Jinhai
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Medical Research Center for Ophthalmic Diseases, China
| | - Sang Zexi
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Medical Research Center for Ophthalmic Diseases, China
| | - Hu Gang
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Medical Research Center for Ophthalmic Diseases, China
| | - Wang Yaohua
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Medical Research Center for Ophthalmic Diseases, China; Jiangxi Institute of Ophthalmology and Visual Science, China; Jiangxi Key Laboratory of Ophthalmology, China.
| | - Liao Hongfei
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Medical Research Center for Ophthalmic Diseases, China; Jiangxi Institute of Ophthalmology and Visual Science, China; Jiangxi Key Laboratory of Ophthalmology, China.
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Risks and Benefits of Surgical Excision of Orbital Cavernous Venous Malformations (So-Called Cavernous Hemangioma): Factors Influencing the Outcome. Ophthalmic Plast Reconstr Surg 2021; 37:248-254. [PMID: 32826827 DOI: 10.1097/iop.0000000000001767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess risks and benefits associated with surgical excision of orbital cavernous venous malformation and analyze factors influencing the outcome. METHODS Design: cohort study. Participants: 164 consecutive patients undergoing surgical removal of orbital cavernous venous malformation. Intervention: lateral or anterior orbitotomy. Outcome measures: visual acuity, visual field, pupillary function, ocular motility, and fundus examination. Influence of the mass volume and tumor location on the outcome was evaluated. The threshold value and risk group for the volume were evaluated using the receiver operating characteristic analysis; 8 orbital different quadrants, extraconal/intraconal position, and orbital apex extension were considered as variables to evaluate the location. RESULTS Postoperatively overall visual acuity (p = 0.0084), visual field (p < 0.0001), diplopia (p < 0.0001), proptosis (p < 0.0001), ocular motility (p = 0.02), ptosis (p = 0.033), choroidal fold (p < 0.0001), disk edema (p = 0.0004) were significantly improved. The commonest location was the lateral quadrant (28%). Choroidal folds were associated with tumor greater than 1100 mm3 (p = 0.001). Visual loss occurred in 2 patients (1.2%) and tonic pupil in 5 (3%,) Visual deterioration was associated with the apical extension (p = 0.001). Pupil efferent defect was associated with lateral quadrant location (p = 0.011) and apical extension (p = 0.05). CONCLUSIONS Surgical removal of orbital cavernous venous malformation is a useful treatment modality, particularly for large size tumors. Removal of cavernous venous malformations located at the lateral aspect of the orbit carries an increased risk of permanent tonic pupil. Postoperative blindness is rarely seen and is often associated with the apical extension. Tailoring the surgical approach, depending on the relative position to the optic nerve, may have an important bearing on outcome.
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Abstract
RATIONAL Cavernous hemangiomas are one of the most common benign primary orbital lesions. These tumors are insidious in onset, slowly progressive and present more often in middle aged women. Multiple orbital cavernous hemangiomas are extremely rare, and only a few cases have been reported in the published literature. PATIENT CONCERNS Here, we report the diagnosis and treatment of multiple cavernous hemangiomas in the right orbit of a female patient with impaired visual acuity and proptosis of the eye for more than 10 years. DIAGNOSIS Magnetic resonance imaging of the orbit showed a giant and irregular soft mass filling the intraconal and extraconal space of the right orbit, compressing the right optic nerve. After tumor resection, histopathological examination confirmed the diagnosis of cavernous hemangioma. INTERVENTIONS A lateral orbitotomy was performed and a total of 13 tumors were excised, with the largest tumor measuring approximately 2.5 × 3.0 cm. OUTCOMES The visual acuity of the patient was preserved, with only a slightly dilated pupil of the right eye. The follow-up period was 6 months with no signs of recurrence. LESSONS Multiple cavernous hemangiomas in the orbit is rare and should be excised surgically as soon as possible.
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Abstract
The recent International Society for the Study of Vascular Anomalies (ISSVA) classification of vascular anomalies can be applied to orbital lesions, dividing them into vascular tumors and vascular malformations. Orbital cavernous hemangiomas are probably best considered cavernous venous malformations under this classification. Management of symptomatic lesions can be with surgical excision or stereotactic fractionated radiotherapy in selected cases. Beta-blockers including propranolol and topical timolol maleate represent first-line therapy for infantile hemangiomas, although surgery has a role in selected cases. Orbital venous-lymphatic malformations are problematic but with improved imaging, neuroradiological intervention, and a multidisciplinary approach to management, outcomes are improving.
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Affiliation(s)
- Timothy John Sullivan
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Ophthalmology, Lady Cilento Children's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
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Abstract
Cavernous hemangioma of the orbit (CHO) is a benign slow-growing lesion of intracanal space. Bilateral orbital cavernous hemangiomas are extremely rare, so that only a few cases have been reported in scientific literature. A 54-year-old patient presented a 1-year history of impaired visual acuity of the left eye. Physical examination showed a left axial propotosis. Orbital magnetic resonance imaging showed a 28 mm diameter intraconal space mass of the left orbit, as well as another 11 mm diameter lesion in the right eye, in the superomedial extraconal space. A superior wall left orbitotomy was performed with a total removal of the tumor. The right lesion was respected. Histopathological examination confirmed the diagnosis of CHO. Bilateral cavernous hemangiomas are extremely rare. Orbital imaging guides the diagnosis. The neurosurgeons prefer craniotomy while ophthalmologists favor various modifications of orbitotomies.
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Affiliation(s)
- Aslam Hentati
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Nidhal Matar
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Hadhemi Dridi
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Soufien Bouali
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
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Gupta S, Kaliki S, Gowrishankar S. Concomitant orbital cavernous haemangioma and schwannoma in a patient. BMJ Case Rep 2017; 2017:bcr-2016-218638. [PMID: 28082308 DOI: 10.1136/bcr-2016-218638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman aged 39 years presented with right eye painless proptosis and decreased vision since 5 months. Right fundus examination revealed optic disc oedema. CT of the orbit revealed a well-defined homogeneous mass in the intraconal space in both orbits. Surgical excisional biopsy of the orbital lesions was performed. Histopathological examination of the right orbital lesion was suggestive of cavernous haemangioma and the left orbital lesion revealed schwannoma. The patient had an unremarkable postoperative course with improved visual acuity. This case illustrates benign orbital masses of 2 different tissues of origin in a single patient, which has not been described in the literature.
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Affiliation(s)
| | - Swathi Kaliki
- Department of Ocular Oncology, L V Prasad Eye Institute, Hyderabad, India
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Das D, Bhattacharjee K, Deka P, Bhattacharjee H, Misra DK, Koul A, Kapoor D, Deka A. An interesting case of angiogenesis in cavernous hemangioma. Indian J Ophthalmol 2016; 64:783-785. [PMID: 27905347 PMCID: PMC5168926 DOI: 10.4103/0301-4738.195005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cavernous hemangioma is the most common orbital tumor in adult. There is lot of literatures for clinicopathological features of this tumor. These tumors had been studied for the model of angiogenesis in many of the experimental setups. We present a case of 34-year-old male with this tumor in the left eye with computerized tomography evidence. Postsurgical laboratory findings gave interesting evidence of tumor angiogenesis with tumor endothelial cells and sprouting of the small vessels endothelial cells. Podosome rosette could be conceptualized from the characteristic patterns seen in the tumor.
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Affiliation(s)
- Dipankar Das
- Department of Ocular Pathology and Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | | | - Panna Deka
- Department of Ocular Pathology and Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | | | | | | | | | - Apurba Deka
- Department of Ocular Pathology and Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Strianese D, Napoli M, Russo C, D'Errico A, Scotti N, Puoti G, Bonavolontà G, Tranfa F, Briganti F. Coexistence of cavernous hemangioma and other vascular malformations of the orbit. A report of three cases. Neuroradiol J 2014; 27:223-31. [PMID: 24750713 DOI: 10.15274/nrj-2014-10016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/09/2014] [Indexed: 11/12/2022] Open
Abstract
Coexistence of orbital cavernous hemangioma and other vascular malformations is unusual and few cases have been reported. We describe the clinical and radiological features of three cases of orbital cavernous hemangiomas associated with other vascular malformations, selected reviewing a series of 181 cases of cavernous hemangiomas. All patients were males (age ranging from 43 to 67 years) without vascular systemic disorders and/or a clinical syndrome. They experienced slow progressive exophthalmos. One of them developed acute pulsatile proptosis (case 2), while another experienced slow progressive diplopia (case 3). In one case vascular lesions were bilateral (case 3) and in two patients two different lesions coexisted in the same orbit (cases 1 and 2). All patients underwent surgical excision, which was partial in two cases. Two patients had cavernous hemangiomas in association with a venous malformation (a varix in case 1 and a lymphangioma in case 2), while in the other ones (case 3) cavernous hemangioma was associated with a low-flow arteriovenous malformation. No patient denied visual impairment postoperatively. Few cases of orbital cavernous hemangiomas coexisting with other vascular malformations have been reported in the literature. This entity seems to be an association of different variants of orbital vascular malformations, presenting with a wide spectrum of clinical forms and probably with the same pathogenesis.
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Affiliation(s)
- Diego Strianese
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy -
| | - Manuela Napoli
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Carmela Russo
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Arianna D'Errico
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Nadia Scotti
- Department of Pediatrics, "Federico II" University; Naples, Italy
| | - Gianfranco Puoti
- I Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Naples, Italy
| | - Giulio Bonavolontà
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Fausto Tranfa
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
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Rootman DB, Heran MKS, Rootman J, White VA, Luemsamran P, Yucel YH. Cavernous venous malformations of the orbit (so-called cavernous haemangioma): a comprehensive evaluation of their clinical, imaging and histologic nature. Br J Ophthalmol 2014; 98:880-8. [DOI: 10.1136/bjophthalmol-2013-304460] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khan SN, Sepahdari AR. Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies. Saudi J Ophthalmol 2013; 26:373-83. [PMID: 23961022 DOI: 10.1016/j.sjopt.2012.08.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A wide variety of space occupying lesions may be encountered in the orbit. CT and MR imaging frequently help confirm the presence of a mass and define its extent. Characteristic imaging features may help distinguish among lesions that have overlapping clinical presentations. This review focuses on some of the common orbital masses. Common vascular lesions that are reviewed include: capillary (infantile) hemangioma, cavernous hemangioma (solitary encapsulated venous-lymphatic malformation), and lymphangioma (venous-lymphatic malformation). Benign tumors that are reviewed include: optic nerve sheath meningioma, schwannoma, and neurofibroma. Malignancies that are reviewed include: lymphoma, metastasis, rhabdomyosarcoma, and optic glioma. Key imaging features that guide radiological diagnosis are discussed and illustrated.
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Affiliation(s)
- Sarah N Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States
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Bagheri A, Khandan S, Salour H, Aletaha M, Abrishami A. Recurrent Orbital Cavernous Hemangioma due to Overlooked Multiple Tumors. J Ophthalmic Vis Res 2012; 7:244-7. [PMID: 23372910 PMCID: PMC3557012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 06/10/2012] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To report late recurrence of orbital cavernous hemangioma in a patient ten years after complete resection of the primary tumor. CASE REPORT A 32-year-old woman with a history of progressive visual loss and proptosis underwent lateral orbitotomy for resection of a large cavernous hemangioma. Ten years later, proptosis recurred and the patient developed progressive ocular deviation. Imaging studies were in favor of a recurrent cavernous hemangioma and the tumor was excised via the previous incision site. Reassessment of previous orbital images suggested the presence of two separate tumors, only one of which had been excised at the time of initial surgery. CONCLUSION Recurrent orbital cavernous hemangioma may follow incomplete excision of multiple orbital lesions with gradual growth of unidentified residual tumors. Accordingly, when an encapsulated cavernous hemangioma is removed, exploration is recommended to rule out multiple lesions.
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Affiliation(s)
- Abbas Bagheri
- Abbas Bagheri, MD. Professor of Ophthalmology, Labbafinejad Medical Center , Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666, Iran; Tel: +98 (21) 2258 5952, Fax: +98 (21) 2259 0607; e-mail:
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Stereotactic fractionated radiotherapy for cavernous venous malformations (hemangioma) of the orbit. Ophthalmic Plast Reconstr Surg 2012; 28:192-5. [PMID: 22581082 DOI: 10.1097/iop.0b013e31824a48f3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cavernous malformations (hemangioma) of the orbit, when symptomatic, can often be treated successfully with complete surgical excision. However, when they involve local structures in their capsule, are situated in the orbital apex, or extend through the superior orbital fissure, the risks of surgery increase significantly. In such cases, alternative treatment modalities can be explored. In this study, the authors report on the use of fractionated stereotactic radiotherapy (SFRT) for the treatment of surgically complicated cavernous malformations. METHODS In this retrospective cohort study, the authors reviewed the clinical and radiologic records of 5 patients treated with SFRT over the past 5 years. RESULTS Patients ranged in age from 30 to 65 years, and 3 out of 5 were female. Two cases involved the cavernous sinus, one involved the ophthalmic artery, one involved the posterior ciliary artery, and the last traversed the superior orbital fissure. Four had significant visual field defects. Each was treated with SFRT. A total dose of 4000 cGy divided into 20,200 cGy fractions was applied for 3 cases, while 2 other cases were treated with total doses of 4563 and 4959 cGy divided into 28 × 162 cGy and 29 × 171 cGy fractions, respectively. Rapid resolution of visual field defect was noted by 3 months, and overall tumor shrinkage was on average 60% (range: 32-79%). Follow-up was on average 23.4 months (range: 5-50 months). No complications of treatment were noted. CONCLUSIONS For symptomatic cavernous malformations demonstrating anatomical position that may increase risk of surgical excision, SFRT is an effective and safe method to control lesion size and improve visual function.
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Pereira PMR, Rodrigues CAC, Lima LLD, Mariano AVDO, Romero SAR. Periorbital hemangiomas: the need for active management - report of two cases. An Bras Dermatol 2011; 86:545-8. [PMID: 21738973 DOI: 10.1590/s0365-05962011000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/17/2010] [Indexed: 11/22/2022] Open
Abstract
Hemangioma is the most common tumor of childhood and is commonly located on the head or neck. The orbit is often affected and early and aggressive intervention is required to prevent serious visual complications. This paper reports on two cases. In the first case, the patient's vision was impaired, while in the second case a deep hemangioma affecting adjacent areas was confirmed radiologically. Treatment with aggressive systemic corticotherapy was successful, thus avoiding permanent damage to the patients' vision. Furthermore, esthetic outcome was satisfactory. The treatment of choice is oral corticosteroids and management should be individualized and should include careful follow-up to monitor possible adverse effects.
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Aletaha M, Salim RE, Bagheri A, Salour H, Abrishami M. Bilateral orbital cavernous hemangiomas. J Ophthalmic Vis Res 2010; 5:65-7. [PMID: 22737330 PMCID: PMC3380673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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[Intraorbital cavernous hemangioma]. ACTA ACUST UNITED AC 2008; 109:312-5. [PMID: 18707746 DOI: 10.1016/j.stomax.2008.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/10/2008] [Accepted: 05/26/2008] [Indexed: 11/23/2022]
Abstract
Cavernous hemangioma is the most frequent primary vascular orbital tumor in adults. This slowly evolving lesion is usually located behind the ocular globe, between the extrinsic muscles. It leads to axial exophthalmia. Surgical treatment is indicated when there is a risk of visual impairment. The prognosis is related to the size of the lesion and its extension. CT scan is rather unspecific, but MRI is highly sensitive and specific in case of progressive painless exophthalmia.
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Paonessa A, Limbucci N, Gallucci M. Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study. Eur J Radiol 2008; 66:282-6. [PMID: 17644295 DOI: 10.1016/j.ejrad.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Revised: 05/14/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described. The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases. We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed. Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.
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Affiliation(s)
- Amalia Paonessa
- Department of Neuroradiology, S.Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
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Bhattacharjee K, Bhattacharjee H, Deka A. Acute progressive multiple cavernous hemangiomas of orbit in a child--a case report. Orbit 2007; 26:117-9. [PMID: 17613859 DOI: 10.1080/01676830600972781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Orbital cavernous hemangioma, a slowly progressive tumor of middle aged women is usually unilateral and solitary. We report a case of rapidly progressive multiple cavernous hemangiomas of the orbit in a young male patient.
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Kashkouli MB, Imani M, Tarassoly K, Tarrasoly K, Kadivar M. Multiple Cavernous Hemangiomas Presenting as Orbital Apex Syndrome. Ophthalmic Plast Reconstr Surg 2005; 21:461-3. [PMID: 16304530 DOI: 10.1097/01.iop.0000180756.32324.c3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 41-year-old man presented with a 7-year history of gradually increasing right proptosis and a 2-year history of decreased vision and limited eye movements. Right proptosis (11 mm), limitation of movement in all gazes, anisocoria, and visual impairment implied orbital apex compression. Computed tomography showed several distinct lesions with mild delayed enhancement extending to the orbital apex. Through a lateral orbitotomy, 10 discrete hemangiomas were removed uneventfully. Histopathologic findings were consistent with cavernous hemangioma in all tumors removed. Proptosis resolved after surgery at 3 to 4 weeks. Visual acuity was unchanged (20/25), and eye movement significantly improved at last follow-up, 15 months after surgery.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Oculoplastic Service, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Abstract
CT and MR imaging are particularly important in the diagnostic investigation of patients with vascular disorders of the orbit. The improved image quality of CT and MR imaging, along with dynamic CT angiography, MR angiography, MR venography, and multiphase dynamic contrast CT/MR imaging, has proven useful to delineate as well as differentiate various orbital vascular lesions. This article presents the current classification of orbital vascular disorders and describes the CT/MR imaging characteristics of orbital cavernous hemangiomas and simulating lesions.
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Affiliation(s)
- Sameer A Ansari
- Department of Radiology, University of Illinois Hospital at Chicago, University of Illinois College of Medicine, 1801 West Taylor Street, MC 711, Chicago, IL 60612, USA
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Scheuerle AF, Steiner HH, Kolling G, Kunze S, Aschoff A. Treatment and long-term outcome of patients with orbital cavernomas. Am J Ophthalmol 2004; 138:237-44. [PMID: 15289133 DOI: 10.1016/j.ajo.2004.03.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the long-term prognosis of visual function in patients with orbital cavernomas after conservative and surgical treatment. DESIGN Interventional case series. METHODS The authors describe the outcome of 20 patients with cavernous hemangiomas of the orbit treated in their departments between 1988 and 2003. This prospective study included five cases followed by clinical and radiologic observation and 15 cases of symptomatic tumors that were completely removed by means of a frontotemporal or by means of a transconjunctival approach. The clinical characteristics of orbital cavernomas were analyzed together with their appropriate treatment. Furthermore, the authors present the unusual case of a patient suffering from progressive visual deterioration from a cerebral cavernoma compressing the optic nerve. RESULTS The follow-up period was between 3 and 10 years. All orbital cavernomas in the group of conservatively managed patients remained stable. The transconjunctival excision of a medially located lesion was uncomplicated. The frontotemporal approach was chosen for large tumors situated in the proximity of the orbital apex and was associated with a higher number of complications. A good overall outcome of visual function and patient satisfaction was achieved in 11 of 14 cases operated on by craniotomy. CONCLUSION The combination of clinical signs and magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of orbital cavernomas. In the presence of visual deterioration clearly attributable to the tumor we recommend immediate surgery, while lesions producing solely exophthalmos can safely be followed by observation. The transcranial approach offers excellent exposure and a rewarding cosmetic result and may be considered for large lesions superior and medial to the optic nerve, especially if they involve the orbital apex.
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Chang EL, Rubin PAD. Bilateral multifocal hemangiomas of the orbit in the blue rubber bleb nevus syndrome. Ophthalmology 2002; 109:537-41. [PMID: 11874758 DOI: 10.1016/s0161-6420(01)00989-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report the clinical findings and surgical treatment of multifocal, bilateral orbital hemangiomas in a patient with the blue rubber bleb nevus syndrome, a rare vascular disorder characterized by distinctive cutaneous and visceral hemangiomas. DESIGN Interventional case report. METHODS Review of clinical findings, radiologic studies, and treatment of the patient. RESULTS A 36-year-old female with multifocal, bilateral orbital lesions was seen with severe proptosis and decreased visual acuity of the left eye. Surgical debulking of multiple cavernous hemangiomas of the orbit resulted in decreased proptosis and an improvement in visual acuity. Subsequent histopathologic analysis and the results of a systemic workup revealing multiple, distinctive, cutaneous and visceral lesions were found to be consistent with the blue rubber bleb nevus syndrome. CONCLUSIONS Although hemangiomas of the orbit are relatively common occurrences, multifocal, bilateral lesions may exist in the setting of underlying systemic hemangiomatosis. Bilateral or multifocal hemangiomas associated with cutaneous or visceral lesions should alert the clinician to the possibility of a number of syndromes that may have life-threatening consequences.
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Affiliation(s)
- Eli L Chang
- Ophthalmic Plastic, Orbital and Cosmetic Surgery Service, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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23
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Abstract
Vascular lesions represent an important subgroup of orbital abnormalities; however, there is much controversy regarding their pathophysiology and nomenclature. Attempts at resolution of some of the issues have resulted in changes of names of some of the lesions (e.g., lymphangioma to venolymphatic malformation). Imaging plays an important role in delineation and characterization of these lesions. A radiologist informed about the pathophysiology and attentive to the internal architecture of the lesions shown on images, particularly MR images, often can predict the histologic diagnosis. Imaging information helps clarify some of the controversies surrounding these lesions.
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Affiliation(s)
- L T Bilaniuk
- Department of Radiology, Children's Hospital of Philadelphia, Pennsylvania, USA
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24
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Abstract
Eighty-five vascular lesions of the orbit examined and treated between 1963-1993 were reviewed retrospectively to reveal the types of vascular tumors, age and sex distribution, clinical characteristics, treatment options and prognosis. Capillary hemangioma was the most frequent orbital vascular tumor accounting for 37 of 85 cases making up 43.5% of the entire orbital masses. Cavernous hemangioma accounted for 35 cases (41.2%), varices for 3 cases (3.5%), anteriovenous malformations for 3 cases (3.5%), angiosarcomas for 3 cases (3.5%), lymphangiomas for 3 cases (3.5%) and hemangiopericytoma for one case (1.2%). Of the 85 vascular tumor cases 43 were encountered in children aged 18 years or less. Capillary hemangioma was the most frequent pediatric orbital vascular lesion, making up 86% of the vascular tumors in this age group. Capillary hemangiomas have been treated with observation and intralesional corticosteroid injections. Cavernous hemangiomas, vascular malformations, lymphangiomas and two cases of angiosarcomas received orbitotomy. One case each of angiosarcoma and hemangiopericytoma underwent exenteration because of the advanced stage of the lesion. There was one tumor-related death who was a 9-year-old boy diagnosed with angiosarcoma. Vascular tumors with the exception of angiosarcomas and hemangiopericytoma behaved as benign lesions.
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Affiliation(s)
- I Günalp
- Ocular Oncology Department, Faculty of Medicine, University of Ankara, Turkey
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