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Biswas A, Wong OY, Aygun B, Gore S, Mankad K. Extraocular Orbital and Peri-Orbital Masses. Neuroimaging Clin N Am 2023; 33:643-659. [PMID: 37741663 DOI: 10.1016/j.nic.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In this article, we will describe relevant anatomy and imaging findings of extraocular and orbital rim pathologic conditions. We will highlight important clinical and imaging pearls that help in differentiating these lesions from one another, and provide a few practical tips for challenging cases.
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Affiliation(s)
- Asthik Biswas
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
| | - Oi Yean Wong
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Berna Aygun
- Department of Neuroradiology, UK Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Bartoletti V, Rios-Zermeno J, El-Sayed I, Abla AA, Rodriguez Rubio R. Morphometric Analysis of the Ophthalmic and Central Retinal Arteries via the Endoscopic Endonasal Trans-Ethmoidal Approach: Surgical Relevance of Vascular Components within the Medial Intraconal Zones. World Neurosurg 2023:S1878-8750(23)00563-6. [PMID: 37100115 DOI: 10.1016/j.wneu.2023.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) offers a minimally invasive route to treat medial intraconal space (MIS) lesions. Understanding the configuration of the ophthalmic artery (OphA) and the central retinal artery (CRA) is crucial. METHODS An EEA to the MIS was performed on 30 orbits. The description of the intraorbital part of the OphA was divided into three segments and classified as type 1 and type 2 and the MIS was divided into three surgical zones (A, B, C). The CRA's origin, course, and point of penetration (PP) were analyzed. The relationship between the position of the CRA in the MIS and the OphA type was analyzed. RESULTS The OphA type 2 was present in 20% of specimens. The site of origin of the CRA from the OphA was found on the medial surface in type 1 and on the lateral surface of type 2. The PP of the CRA was found in 87% of the specimens on the inferomedial surface, just anterior to the inferior muscular trunk, at an average distance of 9.5mm ± 1 from the globe and 17mm ± 1.5 from the AZ. The presence of the CRA in Zone C was associated only with OphA type 1. CONCLUSION OphA type 2 is a common finding and can compromise the feasibility of an EEA to the MIS. A detailed preoperative analysis of the OphA and CRA should be conducted prior to approaching the MIS due to the implications of the anatomical variations that can compromise safe intraconal maneuverability during an EEA.
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Affiliation(s)
- Viola Bartoletti
- Neurosurgery, Department of Neuroscience, University of Padua, Padua, Italy; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA
| | - Jorge Rios-Zermeno
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Neurological Surgery, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | - Ivan El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Adib A Abla
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Roberto Rodriguez Rubio
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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Sharma AK, Gandhoke CS, Misra S, Ravi A, Gupta RK, Gupta SK. Ectopic intraconal orbital meningioma - A rare case report. Surg Neurol Int 2021; 12:305. [PMID: 34345446 PMCID: PMC8326082 DOI: 10.25259/sni_84_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background Ectopic orbital meningiomas (OM) are a rare subset of OMs which are neither attached to the optic nerve sheath nor to the surrounding bone. Case Description We report the case of a 65-year-old female who presented with a 1 year history of proptosis followed by visual loss and restricted right eye movements since 3 months. Radiology of the orbits was suggestive of intraorbital, intraconal, and heterogeneous contrast enhancing right eye lesion which was completely excised through supraorbital orbitotomy approach. Intraoperatively, the right optic nerve, though compressed, and displaced inferiorly, was free from the lesion. The final histopathological diagnosis was "Meningioma WHO Grade I." At 3 months follow-up, patient's vision in the right eye improved from perception of light positive to 6/12 and there was no evidence of recurrence. Conclusion Rarity of ectopic OM, total surgical excision with an excellent postoperative visual outcome prompted us to report this case.
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Affiliation(s)
- Anil Kumar Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Somen Misra
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ashik Ravi
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Rakesh Kumar Gupta
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Surendra Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Mahuvakar AD, Nair D, Pai PS. Transnasal Endoscopic Resection of the Intraconal Metastases From Renal Cell Carcinoma: a Case Report and Review of Literature. Indian J Surg Oncol 2020; 11:318-322. [PMID: 33364728 DOI: 10.1007/s13193-020-01237-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most common malignancy to cause metastasis to sinonasal cavity. These metastases can occasional cause invasion into the orbit. Isolated intraconal intraorbital metastasis from RCC is very rare. We hereby describe a case of 72-year-old female, who underwent right nephrectomy for RCC, 8 years back, and now presenting with a space occupying lesion in the right intraorbital intraconal compartment with no involvement of the paranasal sinuses. En bloc resection of the tumor was achieved via transnasal endoscopic approach. This is a rare case where minimally invasive surgery was done for metastatic lesion, with minimal postoperative morbidity.
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Affiliation(s)
- Ankit D Mahuvakar
- Department of Head Neck Surgical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Deepa Nair
- Department of Head Neck Surgical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Prathamesh S Pai
- Department of Head Neck Surgical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
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Thavara BD, Rajagopalawarrier B, Balakrishnan S, Kidangan GS. A Case of Adult Orbital Intraconal Lymphangioma. Asian J Neurosurg 2020; 15:168-171. [PMID: 32181195 PMCID: PMC7057866 DOI: 10.4103/ajns.ajns_282_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/17/2019] [Indexed: 12/03/2022] Open
Abstract
Orbital lymphangioma is an intra-orbital, nonencapsulated, congenital vascular tumor with a propensity for recurrent hemorrhage. It is a common vascular tumor in children below 10 years of age. Adult orbital intraconal lymphangiomas are very rare. The authors present a case of 68-year-old male patient presented with left eye symptoms of decreased vision, proptosis, restricted eye movement, and diplopia. The symptoms started following a trauma to the left eye 6 months back. Contrast magnetic resonance imaging scan showed a contrast enhancing well-defined 2.2 cm × 1.8 cm × 1.8 cm fairly rounded, slightly lobulated intraconal tumor in the retrobulbar region inferior to optic nerve. Patient underwent the left fronto-temporo-orbito-zygomatic (FTOZ) craniotomy. The tumor was moderately vascular, firm in consistency with lobulated surface. Few foci of hemorrhages were seen. Near total excision of the tumor was done. Histopathology and immunohistochemistry confirmed the diagnosis of orbital lymphangioma. Although rare, intraconal orbital lymphangioma should be kept in the differential diagnosis of orbital tumors presenting in adult patients following a trauma. It can radiologically mimic other intraorbital tumors. It is a surgical challenge and FTOZ craniotomy provides direct access to the orbital intraconal compartment.
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Affiliation(s)
| | | | | | - Geo Senil Kidangan
- Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
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Abstract
Orbital lymphangioma is an infrequent benign cystic lesion manifesting in childhood and presenting with slowly progressive proptosis, and restriction of eye movements. Here we report a rare case of 8 year old male patient presenting with unilateral painful proptosis and subconjunctival hemorrhage with decrease of vision and restriction of eye movements. CT scan and MRI were done which revealed an intraorbital and intraconal cystic space occupying lesion. Fronto-orbito zygomatic craniotomy was done for orbital decompression and subtotal excision of tumor and blood evacuation. Histopathological findings were suggestive of lymphangioma.
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Affiliation(s)
- G Prakash Rao
- Department of Neurosurgery, Gandhi Medical College and Hospital, Padmarao Nagar, Secunderabad, Telangana, India
| | - M Siddartha Reddy
- Department of Neurosurgery, Gandhi Medical College and Hospital, Padmarao Nagar, Secunderabad, Telangana, India
| | - Imran Mohammed
- Department of Neurosurgery, Gandhi Medical College and Hospital, Padmarao Nagar, Secunderabad, Telangana, India
| | - K Arjun Reddy
- Department of Neurosurgery, Gandhi Medical College and Hospital, Padmarao Nagar, Secunderabad, Telangana, India
| | - E Swathi Reddy
- Department of Ophthalmology, Pushpagiri Vitreo Retinal Institute and Hospital, Secunderabad, Telangana, India
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Yang B, Zhao J, Gao L, Li CL, Liu XR, Jiao H, Liao ZY, Yi C. CT-Guided Percutaneous Sclerotherapy for Low-Flow Retrobulbar Intraconal Venous Malformations. Cardiovasc Intervent Radiol 2018; 41:496-501. [PMID: 29067510 DOI: 10.1007/s00270-017-1822-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Until now, no study has focused exclusively on low-flow retrobulbar intraconal venous malformations (RIVMs) which may require treatment due to cosmetic defect, pain, and visual dysfunction. The treatment for RIVMs which surround the optic nerve remains challenging. This case series aimed to evaluate the technical feasibility, effectiveness, and safety of percutaneous sclerotherapy with polidocanol for low-flow RIVMs, using local anesthesia. METHOD This is a prospective, non-comparative, single-center, interventional case series. All patients signed informed consent forms. Seven patients with RIVMs were treated with percutaneous sclerotherapy with polidocanol/air foam using CT guidance. Primary endpoints are reduction in the volume of RIVMs and pain relief assessed by visual analog scale (VAS). Secondary endpoints are exophthalmos and recording adverse events obtained in clinical follow-up during outpatient visits. RESULTS Results revealed that the mean volume of RIVMs was decreased from 12.05 ± 6.35 cm3 preoperatively to 1.56 ± 0.43 cm3 postoperatively, (p = 0.005), with a mean decrease of 87.05%. The intraocular pressure was decreased from 14.19 ± 2.99 to 11.79 ± 1.25 mmHg, (p = 0.043). The mean VAS score was decreased from 3.43 ± 2.37 preoperatively to 1.29 ± 0.76 postoperatively, (p = 0.023). The exophthalmos score was decreased from 1.75 ± 0.27 to 1.34 ± 0.31 cm, (p = 0.005). All patients were satisfied with the treatment, which did not leave a postoperative scar. CONCLUSIONS The results of percutaneous intralesion injection of polidocanol for RIVMs are encouraging. The present results suggest that this method could be a safe and effective treatment option for patients with RIVMs.
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Hemalatha AL, D V, M G, M B, S G. Rare retro-orbital intraconal occurrence of benign schwannoma - a case report. J Clin Diagn Res 2014; 7:2964-5. [PMID: 24551692 DOI: 10.7860/jcdr/2013/6827.3810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/30/2013] [Indexed: 11/24/2022]
Abstract
Schwannomas otherwise referred to as neurilemmomas are benign, slowly progressing, encapsulated tumors arising from Schwann cells in the peripheral nerve sheath. They may grow along any peripheral or cranial nerve. Amongst the cranial nerve schwannomas, the eigth cranial nerve is the commonest site. But orbit is a rare site for their occurrence. Solitary orbital schwannomas account for 1% of orbital neoplasms. Orbital schwannomas arise from 3(th), 4(th), 6(th) cranial nerves and ciliary ganglion. Since complications like optic nerve compression and atrophy are likely to occur, early diagnosis is imperative for appropriate management. The present case deals with the rare occurrence of a retro-orbital, intraconal schwannoma in a 23-year-old lady who was clinically and radiologically diagnosed to have a retro-orbital cavernous hemangioma. The variable presentation and location of this tumor can certainly make the diagnosis difficult which may be confirmed only by histopathological examination as in the present case. Our patient underwent a successful complete surgical excision before any complications could ensue.
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Affiliation(s)
- A L Hemalatha
- Professor & Head, Department of Pathology - RGUHS, Mysore Medical College and Research Institute , Mysore, India
| | - Vani D
- Assistant Professor, Department of Pathology - RGUHS, Mysore Medical College and Research Institute , Mysore, India
| | - Giripunja M
- PG Student, Department of Pathology - RGUHS, Mysore Medical College and Research Institute , Mysore, India
| | - Bharathi M
- Professor, Department of Pathology - RGUHS, Mysore Medical College and Research Institute , Mysore, India
| | - Geetanjali S
- PG Student, Department of Pathology - RGUHS, Mysore Medical College and Research Institute , Mysore, India
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