1
|
Allen RC, Diab MM. A swinging upper eyelid approach for excision of lacrimal gland masses. Orbit 2024:1-6. [PMID: 38743616 DOI: 10.1080/01676830.2024.2350036] [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: 01/09/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To describe a novel transconjunctival technique for excision of well-defined masses of the orbital lobe of the lacrimal gland. METHODS Case series of three patients undergoing excision of a well-defined mass of the orbital lobe of lacrimal gland using a swinging upper eyelid flap. This technique entails a supratarsal conjunctival incision combined with lateral canthotomy and superior cantholysis. RESULTS Complete removal of the mass without visible scars was achieved in all cases. There were no complications related to this approach. CONCLUSION The swinging upper eyelid approach produces a wide exposure of the superolateral orbit. It allows safe removal of large lacrimal gland masses without the need for bone removal, while affording acceptable cosmesis.
Collapse
Affiliation(s)
- Richard C Allen
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Texas Oculoplastics Consultants, Austin, TX, USA
| | - Mostafa Mohammed Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| |
Collapse
|
2
|
Lin SN, Wu YM, Siow TY, Yeh CH, Toh CH, Tseng TY, Wong HF. Sclerotherapy with intralesional bleomycin injection under guidance of multi-slice CT for retrobulbar orbital low-flow vascular lesions-single-center experience. Br J Radiol 2024; 97:186-194. [PMID: 38263834 PMCID: PMC11027304 DOI: 10.1093/bjr/tqad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This study investigated the safety and efficacy of sclerotherapy with intralesional bleomycin injection (IBI) for retrobulbar orbital low-flow vascular lesions under multi-slice computed tomography (CT) guidance. METHODS Between January 2010 and September 2021, consecutive patients with retrobulbar orbital low-flow vascular lesions who underwent CT-guided IBI at a tertiary centre in Taiwan were enrolled. Their medical records and imaging data were retrospectively collected. RESULTS This study enrolled 13 patients (7 male and 6 female patients; age range: 1-57 years; mean age: 25.9 years) with lymphatic malformation (LM, n = 4), venolymphatic malformation (n = 1), and venous malformation (VM, n = 8). The overall radiological response rate was 76.9% (10 of 13); the radiological response rate was 75.0% in the VM group (6 of 8) and 75.0% in the LM group (3 of 4). Moreover, 3 patients (23.1%) had minor complications and 1 (7.7%) had a major complication. The mean clinical and radiological follow-up was 8.3 months and no recurrence or progression was reported. CONCLUSION CT-guided IBI is an effective and relatively safe minimally invasive treatment for retrobulbar orbital low-flow vascular lesions, with an overall radiological response rate of 76.9% in a mean of 1.5 sessions and a low complication rate. ADVANCES IN KNOWLEDGE CT-guided sclerotherapy with IBI is a relatively safe, effective, and feasible alternative treatment option for retrobulbar orbital low-flow vascular lesions.
Collapse
Affiliation(s)
- Shin-Nan Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Tiing-Yee Siow
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Ti-Yung Tseng
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Ho-Fai Wong
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| |
Collapse
|
3
|
Vahdani K, Rose GE. Incidence and Risk Factors for Poor Postoperative Visual Outcome After Excision of Orbital Cavernous Venous Malformations. Ophthalmic Plast Reconstr Surg 2023; 39:440-448. [PMID: 36880998 DOI: 10.1097/iop.0000000000002342] [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: 03/08/2023]
Abstract
AIMS To determine the incidence and risk factors for poor postoperative visual outcome (PPVO) after removal of orbital cavernous venous malformations (OCVMs). METHODS Retrospective case-note and imaging review for patients undergoing excision of OCVMs, with estimation of odds-ratios (ORs) and relative risks (RRs) for visual loss in relation to the position of the mass, surgical approach, and patient factors. RESULTS The 290 patients (179 female; 62%) presented at a mean age of 46.4 years: 243/287 (85%) OCVMs were intraconal, with 213/243 (88%) located freely in the posterior two-thirds of the orbit, and 30/243 (12%) wedged tightly in the apex. PPVO was observed in 6.9% (20/290) patients, solely after removal of intraconal lesions, Univariate analysis showed increased risk with preoperative relative afferent pupillary defect (RAPD) (14/107 [13%]; RR 2.9; P = 0.011), apical lesions (9/30 [30%]; RR 5.8; P < 0.001), situated below optic nerve (15/115 [13%]; RR 3.3; P = 0.007), fibrous masses (14/78 [18%]; RR 6.7; P = 0.005), or intraoperative diastolic blood pressure below 50mmHg (10/64 [16%]; RR 2.8; P = 0.007). Multivariate analysis found apical extension (OR 4.9; P = 0.036) and fibrous lesions (OR 10.0; P = 0.035) as strongest predictors for PPVO. The incidence of complete visual loss (no light perception) was 4.1% (12/290); half of these patients had preoperative acuity of counting fingers or worse, 8 (67%) had RAPD, 7 (58%) wedged apical lesions, and 8 (67%) were below the optic nerve. CONCLUSION PPVO after excision of OCVMs can occur in up to 5% of "free" retrobulbar intraconal lesions and in approximately one-third of apical lesions.
Collapse
Affiliation(s)
- Kaveh Vahdani
- Orbital Service, Moorfields Eye Hospital, London, United Kingdom
| | | |
Collapse
|
4
|
Chen YC, Tsai CC, Chen SJ, Wu HM, Yang HC, Chen CJ, Hu YS, Lin CJ, Guo WY, Pan DHC, Chung WY, Lee CC. Stereotactic radiosurgery for orbital cavernous hemangiomas. J Neurosurg 2023; 138:1622-1629. [PMID: 37856889 DOI: 10.3171/2022.8.jns221222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to assess the safety and efficacy of single-session Gamma Knife radiosurgery (GKRS) for orbital cavernous hemangiomas (OCHs). METHODS Patients who presented with an OCH between September 1999 and May 2022 and were treated with single-session GKRS were included in this single-center cohort study. RESULTS There were 23 patients (7 males and 16 females) in this study. The median margin dose was 12 Gy (range 11-13 Gy). The median clinical and radiological follow-ups were 45 months (range 5-190 months) and 45 months (range 6-190 months), respectively. Nine (69.2%) of 13 patients with visual acuity impairment had improvement in best corrected visual acuity. Of the 8 patients with visual field defects, 5 patients (62.5%) had complete resolution. Tumor regression was observed in 22 patients (95.7%). The mean relative reduction in tumor volume was 82.6% ± 23.7%. The relative reductions in tumor volume were 33%, 49%, 72%, 84%, and 89% at 6, 12, 24, 36, and 48 months, respectively. Adverse effects of radiation were not observed. CONCLUSIONS GKRS appears to be safe and efficacious for treating OCHs over long-term follow-up. The treatment is associated with a high rate of regression in OCHs and remarkable improvement in both visual acuity and visual field deficits.
Collapse
Affiliation(s)
- You-Cong Chen
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chieh-Chih Tsai
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Departments of3Ophthalmology and
| | - Shih-Jen Chen
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Departments of3Ophthalmology and
| | - Hsiu-Mei Wu
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 4Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Jen Chen
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Yong-Sin Hu
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 4Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 4Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 4Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Chi Pan
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 7Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yuh Chung
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chia Lee
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 5Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
5
|
Mombaerts I, Allen RC. The transconjunctival orbitotomy: A versatile approach to the orbit and beyond. Surv Ophthalmol 2023; 68:265-279. [PMID: 36372115 DOI: 10.1016/j.survophthal.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
In the management of orbital disorders and defects, minimally invasive surgical approaches have become increasingly efficient for their reduction of operative trauma and access without compromise of therapeutic benefit or diagnostic yield. Various approaches have focused on bone- and canthal-sparing techniques and concealed and small skin incisions. We review the current state of knowledge of procedures to enter the orbit via the conjunctiva. Any quadrant of the orbit can be accessed via the conjunctiva. Surgical incisions involve the orbital palpebral, forniceal, and bulbar conjunctiva. According to the location, nature, and size of the lesion, the transconjunctival orbitotomy can be used as a single procedure, in combination with a caruncular approach or as an adjunct in a multidisciplinary procedure for lesions extending deep into or outside the orbit. The working space and field of operating view can be expanded by releasing the horizontal tension of the eyelid with a lateral cantholysis, lateral paracanthal blepharotomy, or medial lid split procedure. Complications related to the conjunctival incision are reduced to dry eye disease.
Collapse
Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.; Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Kaveh Vahdani
- Orbital Service, Moorfields Eye Hospital, London, United Kingdom
| | | |
Collapse
|
7
|
Machine Learning Based Non-Enhanced CT Radiomics for the Identification of Orbital Cavernous Venous Malformations: An Innovative Tool. J Craniofac Surg 2022; 33:814-820. [PMID: 35025826 DOI: 10.1097/scs.0000000000008446] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the capability of non-enhanced computed tomography (CT) images for distinguishing between orbital cavernous venous malformations (OCVM) and non-OCVM, and to identify the optimal model from radiomics-based machine learning (ML) algorithms. METHODS A total of 215 cases of OCVM and 120 cases of non-OCVM were retrospectively analyzed in this study. A stratified random sample of 268 patients (80%) was used as the training set (172 OCVM and 96 non-OCVM); the remaining data were used as the testing set. Six feature selection techniques and thirteen ML models were evaluated to construct an optimal classification model. RESULTS There were statistically significant differences between the OCVM and non-OCVM groups in the density and tumor location (P < 0.05), whereas other indicators were comparable (age, gender, sharp, P > 0.05). Linear regression (area under the curve [AUC] = 0.9351; accuracy = 0.8657) and Stochastic Gradient Descent (AUC = 0.9448; accuracy = 0.8806) classifiers, both of which coupled with the f test and L1-based feature selection method, achieved optimal performance. The support vector machine (AUC = 0.9186; accuracy = 0.8806), Random Forest (AUC = 0.9288; accuracy = 0.8507) and eXtreme Gradient Boosting (AUC = 0.9147; accuracy = 0.8507) classifier combined with f test method showed excellent average performance among our study, respectively. CONCLUSIONS The effect of non-enhanced CT images in OCVM not only can help ophthalmologist to find and locate lesion, but also bring great help for the qualitative diagnosis value using radiomic-based ML algorithms.
Collapse
|
8
|
Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy. Ophthalmic Plast Reconstr Surg 2021; 38:300-303. [PMID: 34812183 DOI: 10.1097/iop.0000000000002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland. METHODS Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland's orbital lobe on an intact sheet of periosteum, an anterior "flip" of the mass (out of the orbit, past the orbital rim) "hinged" at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass. RESULTS Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19-85 years) and 51.1 years without (median, 50.3; range, 11-81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6-15.0 ml with osteotomy; 0.9-15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size. CONCLUSIONS In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.
Collapse
|
9
|
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.
Collapse
|
10
|
Azad AD, Sears CM, Hwang PH, Mohyeldin A, Fernandez-Miranda J, Kossler AL. Multi-compartment skull base orbital cavernous venous malformation: A rare presentation of a common orbital mass. Am J Ophthalmol Case Rep 2021; 21:101020. [PMID: 33598587 PMCID: PMC7868709 DOI: 10.1016/j.ajoc.2021.101020] [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: 07/24/2020] [Revised: 11/09/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose We present a unique case of an orbital intraconal cavernous venous malformation that extended along the trigeminal nerve to the pterygopalatine and middle cranial fossa. Our aim is to describe an atypical presentation of this common orbital vascular mass. Observations A 57-year-old female presented with right eye proptosis. Orbital magnetic resonance imaging demonstrated a lobulated contrast-enhancing mass involving the right intraconal orbital space, pterygopalatine fossa, and right middle cranial fossa, radiographically presumed to be a schwannoma. Intraoperative and histopathologic evaluation confirmed a cavernous venous malformation that extended along the trigeminal nerve. The mass, including its attachments to the cranial nerves and dura, was successfully removed via a combined transorbital and endoscopic endonasal approach. The patient recovered well with 20/20 vision, full extraocular movements, and resolution of proptosis. Conclusions This a rare presentation of an orbital cavernous venous malformation not previously described. Cavernous venous malformations typically present as ovoid well-circumscribed lesions; however, they can also extend outside the orbit along the path of cranial nerves, as was observed in this case. These types of lesions should be included in the differential diagnosis of masses arising from or extending along cranial nerves, even when involving the orbit.
Collapse
Affiliation(s)
- Amee D Azad
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Connie M Sears
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Ahmed Mohyeldin
- Department of Neurosurgery, Stanford Neuroscience Health Center, Stanford University, Palo Alto, CA, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford Neuroscience Health Center, Stanford University, Palo Alto, CA, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
11
|
Mohammad AA, Abo-Ghadir AA, Othman IS, Abdel-Radi M, Mohammad AENA. Expanded use of transconjunctival orbitotomy in management of different orbital tumors at different locations. Eur J Ophthalmol 2020; 31:2666-2674. [PMID: 33158373 DOI: 10.1177/1120672120968730] [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: 11/15/2022]
Abstract
PURPOSE To assess the surgical outcomes of transconjunctival approach in management of different orbital tumors at different locations. METHODS This prospective, non-comparative, clinical interventional study was conducted in the period between March 2017 and January 2020 and included 61 patients with histologically proved orbital tumors. In all cases, a conjunctival incision near the fornix was made depending on the tumor location as revealed by CT or MRI. A traction suture was applied to one or two relevant recti muscles to guide the globe toward the desired direction. Blunt orbital dissection was made toward the tumor until exposing its anterior surface. The procedure was considered successful if the predetermined decision (total excision with improved clinical manifestations for benign and biopsy for diagnosis in malignant tumors) was achieved without causing permanent complications. The procedure was considered a failure if the predetermined decision was not achieved or if permanent complications developed. RESULTS The patients were divided into: Group A of 47 patients (77.05%) with benign tumors and Group B of 14 patients (22.95%) with malignant tumors. The overall success rate of the approach was 98.36% (60 out of 61 patients), while failure occurred in one case (1.64%). CONCLUSIONS The transconjunctival orbitotomy is an excellent approach to manage different tumors at different orbital locations with rapid recovery and maximum cosmetic results. It is the only approach that can access intra-conal, mid-orbital tumors whatever their relation to the optic nerve without crossing it.
Collapse
Affiliation(s)
- Ahmad A Mohammad
- Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt
| | | | - Ihab S Othman
- Department of Ophthalmology, Cairo University Hospital, Cairo, Egypt
| | | | | |
Collapse
|
12
|
Ghafar AESAES, Saleh SM, Elwehidy AS, Awara AM. Transconjunctival Cryo-Assisted Extraction of Intraconal Cavernous Hemangioma.. [DOI: 10.21203/rs.2.14177/v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background: The aim of this study is to evaluate the safety and efficacy of cryo-assisted transconjunctival orbitotomy for the extraction of intraconal cavernous hemangiomas. Methods: The study was performed at the Mansoura Ophthalmic Center, Mansoura University, Egypt from May 2017 to August 2018 and included 18 patients with orbital intraconal cavernous hemangiomas. In all the cases, preoperative orbital magnetic resonance imaging (MRI) with contrast was performed, the transconjunctival approach was used and cryo-assisted lesion extraction was performed. Cases were followed for six months after the surgery. Results: This study included 18 patients with intraconal cavernous hemangiomas, ten females (55.6%) and eight males (44.4%) with a mean age of 35.6 years. .The hemangiomas were lateral to the optic nerve in eight(44.5%), above the optic nerve in four cases(22.2%), and below the optic nerve in six cases(33.3%). Eight cases had postoperative complications: three cases (16.7%) had postoperative diplopia due to lateral rectus paresis that improved in all three cases within six months, one case (5.6%) had postoperative retrobulbar hemorrhage and proptosis that resolved within two weeks without sequelae, and four cases (22.2%) showed subconjunctival hemorrhages which resolved within two weeks. Of the two cases with preoperative decreases in visual acuity preoperative, one case (5.6%) showed improvement and one case (5.6%) did not improve. Conclusions: Cryoprobe-assisted transconjunctival orbitotomy for the excision of intraconal cavernous hemangiomas is a good approach with minor resolvable complications . Trial registration : Mansoura institutional review board (IRB) Registration number : R/17.05.26 Registration date : 10/5/2017
Collapse
|
13
|
Ghafar AESAES, Saleh SM, Elwehidy AS, Awara AM. Transconjunctival Cryo-Assisted Extraction of Intraconal Cavernous Hemangioma.. [DOI: 10.21203/rs.2.14177/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background: The aim of this study is to evaluate the safety and efficacy of cryo-assisted transconjunctival orbitotomy for the extraction of intraconal cavernous hemangiomas.Methods: The study was performed at the Mansoura Ophthalmic Center, Mansoura University, Egypt from May 2017 to August 2018 and included 18 patients with orbital intraconal cavernous hemangiomas. In all the cases, preoperative orbital magnetic resonance imaging (MRI) with contrast was performed, the transconjunctival approach was used and cryo-assisted lesion extraction was performed. Cases were followed for six months after the surgery.Results: This study included 18 patients with intraconal cavernous hemangiomas, ten females (55.6%) and eight males (44.4%) with a mean age of 35.6 years. .The hemangiomas were lateral to the optic nerve in eight(44.5%), above the optic nerve in four cases(22.2%), and below the optic nerve in six cases(33.3%). Eight cases had postoperative complications: three cases (16.7%) had postoperative diplopia due to lateral rectus paresis that improved in all three cases within six months, one case (5.6%) had postoperative retrobulbar hemorrhage and proptosis that resolved within two weeks without sequelae, and four cases (22.2%) showed subconjunctival hemorrhages which resolved within two weeks. Of the two cases with preoperative decreases in visual acuity preoperative, one case (5.6%) showed improvement and one case (5.6%) did not improve. Conclusions: Cryoprobe-assisted transconjunctival orbitotomy for the excision of intraconal cavernous hemangiomas is a good approach with minor resolvable complications.Trial registration: Mansoura institutional review board (IRB)Registration number: R/17.05.26 Registration date: 10/5/2017
Collapse
|
14
|
Surgical Outcomes of Intraconal Cavernous Venous Malformation According to Their Location in Four Right-Angled Sectors. J Craniofac Surg 2020; 30:1700-1705. [PMID: 30950949 PMCID: PMC7329207 DOI: 10.1097/scs.0000000000005501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The present study evaluated the surgical outcomes of intraconal cavernous venous malformation according to their location in 4 right-angled sectors. Data regarding the surgical method and approach, surgical outcome, and postoperative complications were retrospectively analyzed for 18 patients with intraconal cavernous venous malformations that were surgically treated at the authors' center between March 2006 and May 2017. The lesion location was defined using 2 perpendicular lines connecting the optic disc and the 4 surrounding rectus muscles in the coronal plane, which resulted in the formation of 4 right-angled sectors (upper-outer quadrant, upper-inner quadrant, lower-inner quadrant, and lower-outer quadrant). Accordingly, there were 3, 3, 8, and 4 lesions in the upper-outer, upper-inner, lower-outer, and lower-inner quadrants, respectively. Ten patients received anterior orbitotomy and 8 received lateral orbitotomy. There were no recurrences during the follow-up period. All patients exhibited reduced proptosis after surgery. Vision improved in 4 patients and remained unchanged in 14. Five patients experienced ocular movement limitation (1 permanent and 4 temporary), 1 developed an inferomedial blowout fracture, 2 developed a temporary sensory deficit, and 1 developed temporary ptosis. The authors' findings suggest that intraconal cavernous venous malformations most frequently occur in the lower-outer quadrant. Although most lesions can be removed via anterior orbitotomy, large lesions located near the orbital apex or on the orbital wall require lateral orbitotomy. Ocular movement limitation is a common complication and can become permanent in rare cases, necessitating close monitoring. Lesion location and surgical approach do not seem to influence the postoperative complication rate.
Collapse
|
15
|
ghafar AESAES, Saleh SM, Elwehidy AS, awara AM. Transconjunctival Cryo-Assisted Extraction of Intraconal Cavernous Hemangioma.. [DOI: 10.21203/rs.2.14177/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background: The aim of this study is to evaluate safety and efficacy of transconjunctival cryo-assisted orbitotomy for extraction of intraconal cavernous hemangioma.Methods: The study was performed at the Mansoura ophthalmic center, Mansoura University, Egypt from May 2017 to August 2018, It included 18 patients with orbital intraconal cavernous hemangioma. In all cases, preoperative orbital MRI(magnetic resonance imaging) with contrast was performed, transconjunctival approach was used and cryo-assisted extraction of the lesions was performed. Cases were followed for six months after surgery.Results: This study included 18 patients with intraconal cavernous hemangioma, ten females (55.6%) and eight males (44.4%) with a mean age 35.6 years. Eight cases (44.5%) were lateral to the optic nerve, four cases (22.2%) were above the optic nerve, and six cases (33.3%) were below the optic nerve. Postoperative complications included three cases (16.7%) with postoperative diplopia due to lateral rectus paresis that improved in all cases within six months, one case (5.6%) with postoperative retrobulbar hemorrhage and proptosis that resolved within two weeks without sequelae, and four cases (22.2%) showed subconjunctival hemorrhage which resolved within two weeks. Of the two cases with drop of visual acuity preoperative, one case (5.6%) showed improvement of and one case (5.6%) did not improve. Conclusions: Transconjunctival orbitotomy assisted by the use of the cryoprobe for excision of intraconal cavernous hemangioma represents a good approach with minor resolvable complicationsTrial registration: Mansoura institutional review board (IRB)registration number: R/17.05.26 registration date: 10/5/2017 Keywords: transconjunctival orbitotomy, cryo-assisted extraction of hemangioma, intraconal cavernous hemangioma.
Collapse
|
16
|
Abstract
For removal of tumors and foreign bodies from the orbit, for treatment of severe inflammatory diseases, and for repositioning of bone fragments following fractures or during reconstruction of the bony orbit, several different surgical approaches are available. During the past decade, improved understanding of the pathology and pathophysiology of particular orbital diseases, advancements in clinical endoscopy and microscopy, the introduction of modern imaging techniques for preoperative visualization of pathologic findings, modern approaches to orbital reconstruction, as well as developments in adjuvant therapy have led to a reduction in invasiveness and development of the modern minimally invasive surgical approaches to the orbit usually used today. This review article aims to describe several surgical approaches to the orbit that are nowadays commonly applied-frequently in the context of interdisciplinary therapy-as well as their indications and potential complications. Particular attention is paid to minimally invasive approaches. These different surgical approaches allow a 360-degree exposure of the internal orbital structures with the optic nerve at the center ("round the clock access to the orbit"). The review is complemented by hints and tricks for particular approaches, as well as by a review of the latest literature in the field.
Collapse
Affiliation(s)
- H-J Welkoborsky
- HNO-Klinik, Kopf- und Halschirurgie, regionale plastische Chirurgie, Klinikum Nordstadt, KRH GmbH, Haltenhoffstraße 41, 30167, Hannover, Deutschland.
| | - S K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Castelnuovo P, Arosio AD, Volpi L, De Maria F, Ravasio A, Donati S, Azzolini C, Dallan I, Bignami M, Locatelli D. Endoscopic Transnasal Cryo-Assisted Removal of Orbital Cavernous Hemangiomas: Case Report and Technical Hints. World Neurosurg 2019; 126:66-71. [PMID: 30771539 DOI: 10.1016/j.wneu.2019.01.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cryoprobe devices are used by ophthalmic and orbital surgeons for extraction of fluid-filled intraorbital lesions. No series has described cryodissection via an exclusively transnasal approach. We describe 2 cases of purely endoscopic transnasal removal of intraconal orbital hemangiomas with the aid of a dedicated cryoprobe. METHODS All transnasal endoscopic intraorbital procedures were collected and analyzed. In cases in which intraorbital dissection was performed with the use of an Optikon Cryo-line probe, clinical features, histology, size and location of the lesion, early and late complications, surgical procedure time, and hospital length of stay were analyzed. Patient follow-up included endoscopic endonasal evaluations performed at 2, 4, and 8 weeks after surgery and ophthalmologic and orthoptic evaluations performed 2 days and 2 months after surgery. RESULTS Two transnasal intraorbital endoscopic procedures with the aid of the dedicated Cryo-line probe were collected. Lesions were located in the intraconal space, medial to the optic nerve. In both patients, the histologic evaluation was compatible with cavernous hemangioma, and complete resection was obtained. Mean hospital stay was 5.5 days. Postoperative ophthalmologic and orthoptic evaluations performed 2 months postoperatively revealed complete resolution of preoperative symptoms. CONCLUSIONS Cryoprobes represent an adjunctive tool in the orbital surgeon's armamentarium useful in the extraction of fluid-filled intraorbital lesions. This preliminary experience suggests that their use can ease the removal of intraconal hemangiomas with an exclusively transnasal approach. The analysis of further cases is necessary to confirm safety and efficacy.
Collapse
Affiliation(s)
- Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto D Arosio
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Luca Volpi
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Federico De Maria
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Arianna Ravasio
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Simone Donati
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Claudio Azzolini
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Iacopo Dallan
- First ENT Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio Bignami
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurological Surgery, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| |
Collapse
|
19
|
Bagheri A, Jafari R, Salour H, Aletaha M, Yazdani S, Baghi S. A new surgical technique for excision of orbital cavernous hemangioma: a 15-year experience. Orbit 2018; 37:429-437. [PMID: 29442536 DOI: 10.1080/01676830.2018.1436186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To present a new surgical technique for excision of orbital cavernous hemangiomas (CHs). METHODS This retrospective case series study included patients with orbital CH who were operated from 2001 to 2016 at our referral center. Epidemiologic data, symptoms, signs, and images were reviewed from patients' files with at least one year of follow-up. Surgical results and complications were documented. We used the "index finger dissection" technique without grasping the tumor for release of adhesions and its removal. RESULTS We included 60 patients with orbital CH consisting of 36 (60%) female and 24 (40%) male patients with mean age of 40 ± 12.1 (range 9-66) years. The main complaint was proptosis with average size of 5.3 ± 2 millimeters. The surgical approach was lateral orbitotomy in 49 (81.7%) patients, medial transcutaneous in seven (11.7%) patients, inferior transconjunctival in three (5%) patients, and simultaneous lateral and medial orbitotomy in one (1.6%) patient. All tumors were removed intact; complications included ptosis in one subject, lower lid retraction in one case, and diplopia in two patients, all of which improved before 2 months. No optic nerve damage occurred. CONCLUSION The "index finger dissection" technique without grasping the tumor for excision of orbital CH, via any external approach to the tumor, is a safe technique with minimal complications.
Collapse
Affiliation(s)
- Abbas Bagheri
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Reza Jafari
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Hosein Salour
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Maryam Aletaha
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Shahin Yazdani
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sepehr Baghi
- a Ocular Tissue Engineering Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
Abstract
Postoperative blindness after orbital surgery is an extremely rare and a disastrous complication. Ophthalmic artery occlusion as a cause of such unexpected vision loss has not been documented in literature. The authors report a case of a middle aged man who developed sudden vision loss due to ophthalmic artery occlusion following transconjunctival excision of orbital schwanomma. The possible mechanisms contributing to the loss of vision are discussed and preventive strategies are suggested to reduce the incidence of this complication.
Collapse
|
22
|
Signorelli F, Anile C, Rigante M, Paludetti G, Pompucci A, Mangiola A. Endoscopic treatment of orbital tumors. World J Clin Cases 2015; 3:270-274. [PMID: 25789299 PMCID: PMC4360498 DOI: 10.12998/wjcc.v3.i3.270] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/06/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Different orbital and transcranial approaches are performed in order to manage orbital tumors, depending on the location and size of the lesion within the orbit. These approaches provide a satisfactory view of the superior and lateral aspects of the orbit and the optic canal but involve risks associated with their invasiveness because they require significant displacement of orbital structures. In addition, external approaches to intraconal lesions may also require deinsertion of extraocular muscles, with subsequent impact on extraocular mobility. Recently, minimally invasive techniques have been proposed as valid alternative to external approaches for selected orbital lesions. Among them, transnasal endoscopic approaches, “pure” or combined with external approaches, have been reported, especially for intraconal lesions located inferiorly and medially to the optic nerve. The avoidance of muscle detachment and the shortness of the surgical intraorbital trajectory makes endoscopic approach less invasive, thus minimizing tissue damage. Endoscopic surgery decreases the recovery time and improves the cosmetic outcome not requiring skin incisions. The purpose of this study is to review and discuss the current surgical techniques for orbital tumors removal, focusing on endoscopic approaches to the orbit and outlining the key anatomic principles to follow for safe tumor resection.
Collapse
|
23
|
Yang M, Yan J. Long term surgical outcomes of orbital cavernous haemangiomas (low-flow venous malformations) as performed in a tertiary eye hospital in China. J Craniomaxillofac Surg 2014; 42:1491-6. [DOI: 10.1016/j.jcms.2014.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/10/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
|
24
|
McNab AA, Selva D, Hardy TG, O'Donnell B. The anatomical location and laterality of orbital cavernous haemangiomas. Orbit 2014; 33:359-362. [PMID: 24831510 DOI: 10.3109/01676830.2014.915329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine the anatomical location and laterality of orbital cavernous haemangiomas (OCH). DESIGN Retrospective case series. METHODS The records of 104 patients with OCH were analyzed. MAIN OUTCOME MEASURES The anatomical location of each OCH defined by the location of a point at the centre of the lesion, and its laterality. RESULTS There were 104 patients included in the study. No patient had more than one lesion. Sixteen (15.4%) were located in the anterior third of the orbit, 74 (71.2%) were in the middle third, and 14 (13.5%) in the posterior third. In the middle third, 10 of 74 (13.5%) were extraconal and 64 intraconal (86.5%), with 30 of 64 (46.9%) middle third intraconal lesions lying lateral to the optic nerve. Of 104 lesions, 56 (53.8%) were left sided, showing a trend towards a predilection for the left side (p = 0.065). If data from other published series which included data on laterality is added to our own data and analysed, 270 of 468 (57.7%) OCH occurred in the left orbit (p < 0.005). CONCLUSIONS OCH may occur at almost any location within the orbit. The commonest location is the middle third of the orbit, in the intraconal space lateral to the optic nerve. This may reflect an origin of these lesions from the arterial side of the circulation, as there are more small arteries in the intraconal space lateral to the optic nerve than in other locations. A predilection for the left orbit remains unexplained.
Collapse
Affiliation(s)
- Alan A McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia
| | | | | | | |
Collapse
|
25
|
Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia. J Ophthalmol 2014; 2014:424852. [PMID: 24829795 PMCID: PMC4009292 DOI: 10.1155/2014/424852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/20/2014] [Indexed: 11/17/2022] Open
Abstract
To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females) underwent tumor removal through eyelid crease (17 eyes), conjunctival (nine eyes), lateral canthal (two eyes), and transcaruncular (two eyes) approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range) age and follow-up duration were 48.5 (31-87) years old and 24.5 (4-375) weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases), pleomorphic adenoma (5 cases), solitary fibrous tumor (4 cases), neurofibroma (2 cases), schwannoma (2 cases), and orbital varix (1 case). None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.
Collapse
|
26
|
Castelnuovo P, Dallan I, Locatelli D, Battaglia P, Farneti P, Tomazic PV, Seccia V, Karligkiotis A, Karligktios A, Pasquini E, Stammberger H. Endoscopic transnasal intraorbital surgery: our experience with 16 cases. Eur Arch Otorhinolaryngol 2012; 269:1929-35. [PMID: 22237761 DOI: 10.1007/s00405-011-1917-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 12/28/2011] [Indexed: 01/24/2023]
Abstract
The objective of the study is to present our multicentric experience on intraorbital lesions managed by means of an endonasal endoscopic approach. The study design used was multi-institutional retrospective review. We collected data on 16 intraorbital medially-located lesions, all managed by means of an endonasal route, treated in four different skull base centers. We retrospectively reviewed the technical details, complications, histology, and general outcome. The endoscopic endonasal approach was effective in removing completely intraorbital extra-intraconal tumors in 8 cases, in performing biopsies for histological diagnosis in 6 intraorbital intraconal tumors, and in draining 1 extraconal abscess. No major complications were observed; in particular, there was no optic nerve damage. Minor, temporary complications (diplopia) were seen in 3 cases; only 2 patients experienced a permanent diplopia related to medial rectus muscle impairment, in 1 case associated with enophthalmos. Our preliminary multi-centric clinical experience suggests that medially located intraorbital lesions, and in particular the infero-medial ones, can be successfully and safely managed by such an approach. The well-known advantages of the endoscopic techniques, namely the lack of external scars, less bleeding, shorter hospital stay, and fewer complications, are confirmed.
Collapse
Affiliation(s)
- Paolo Castelnuovo
- ENT Unit, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Eap C, Litre CF, Jazeron JF, Theret E, Duntze J, Patey M, Rousseaux P. [Intradiploic cavernous hemangioma of the calvaria: case report and review of the literature]. Neurochirurgie 2010; 57:42-5. [PMID: 20870256 DOI: 10.1016/j.neuchi.2010.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 07/09/2010] [Indexed: 11/15/2022]
Abstract
We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.
Collapse
Affiliation(s)
- C Eap
- Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 45 rue Cognacq-Jay, Reims, France.
| | | | | | | | | | | | | |
Collapse
|
29
|
Cophignon J, d'Hermies F, Civit T. [Vascular tumors of the orbit]. Neurochirurgie 2010; 56:197-212. [PMID: 20303554 DOI: 10.1016/j.neuchi.2010.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
Vascular tumors of the orbit include capillary hemangioma, cavernous hemangioma, hemolymphangioma, hemangiopericytoma and a few rare tumors. Capillary hemangioma and hemolymphangioma, occurring mainly in children, are covered in the chapter devoted to childhood tumors. In this chapter, cavernous hemangioma and hemangiopericytoma are discussed as well as rare vascular tumors. Although orbital varix is not a tumor, it is also considered because of the diagnostic problems and the close correlation of orbital varix with a true tumor: hemolymphangioma.
Collapse
Affiliation(s)
- J Cophignon
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | | | | |
Collapse
|
30
|
Stamm A, Nogueira JF. Orbital Cavernous Hemangioma: Transnasal Endoscopic Management. Otolaryngol Head Neck Surg 2009; 141:794-5. [DOI: 10.1016/j.otohns.2009.05.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/07/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Aldo Stamm
- São Paulo ENT Center-Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
| | | |
Collapse
|
31
|
AKIYAMA O, TSUTSUMI S, SUGA Y, ABE Y, YASUMOTO Y, ITO M. Orbital Cavernous Hemangioma Presenting With Atypical Appearance -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:209-12. [DOI: 10.2176/nmc.49.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Osamu AKIYAMA
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Satoshi TSUTSUMI
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yasuo SUGA
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yusuke ABE
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yukimasa YASUMOTO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Masanori ITO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| |
Collapse
|