Typical Orbital Pathologies: Hemangioma

Surgical Intervention in Pediatric Orbital Hemangioma: A Case Report

Infantile hemangiomas are common vascular tumors in infancy, typically affecting the skin. However, intraconal orbital hemangiomas are rare and present diagnostic challenges due to their impact on critical structures within the orbit. We present the case of a 1-year-old male with progressive orbital swelling and proptosis. Initial conservative management with propranolol was attempted, but due to the lack of response, surgical resection of the intraconal hemangioma was performed. Pediatric orbital hemangiomas, particularly intraconal variants, pose distinctive diagnostic challenges. While conservative approaches, such as propranolol, align with evolving strategies for infantile hemangiomas, surgical intervention may be necessary in cases with an inadequate response. This case underscores the importance of recognizing the need for timely surgical intervention in pediatric orbital hemangiomas, even after initial conservative measures. Successful surgical outcomes contribute to understanding pediatric orbital pathology and emphasize the ongoing evolution of management strategies in this challenging clinical scenario.

End-to-End Deep-Learning-Based Diagnosis of Benign and Malignant Orbital Tumors on Computed Tomography Images

Determining the nature of orbital tumors is challenging for current imaging interpretation methods, which hinders timely treatment. This study aimed to propose an end-to-end deep learning system to automatically diagnose orbital tumors. A multi-center dataset of 602 non-contrast-enhanced computed tomography (CT) images were prepared. After image annotation and preprocessing, the CT images were used to train and test the deep learning (DL) model for the following two stages: orbital tumor segmentation and classification. The performance on the testing set was compared with the assessment of three ophthalmologists. For tumor segmentation, the model achieved a satisfactory performance, with an average dice similarity coefficient of 0.89. The classification model had an accuracy of 86.96%, a sensitivity of 80.00%, and a specificity of 94.12%. The area under the receiver operating characteristics curve (AUC) of the 10-fold cross-validation ranged from 0.8439 to 0.9546. There was no significant difference on diagnostic performance of the DL-based system and three ophthalmologists (p > 0.05). The proposed end-to-end deep learning system could deliver accurate segmentation and diagnosis of orbital tumors based on noninvasive CT images. Its effectiveness and independence from human interaction allow the potential for tumor screening in the orbit and other parts of the body.

Orbital hemangioma extirpation via a transnasal endoscopic surgical approach: A case report

INTRODUCTION

Orbital tumors are heterogeneous lesions originating from various structures in the eyeball, including the extraconal, conal, and intraconal spaces. One orbital tumor type is a vascular tumor, such as a hemangioma. Hemangiomas are most common in women aged 20-64 years. They are painless and slow-growing, leading to proptosis. The diagnosis can generally be established by clinical examination and computed tomography (CT) or magnetic resonance imaging scans. Orbital hemangioma management can involve regular observation of small and asymptomatic tumors or surgery for large symptomatic tumors.

PRESENTATION OF CASE

We report a 20-year-old Asian woman who presented with swelling on the medial side of her right eyelid that had increased over the last three months. A non-contrast head CT scan showed a mass in the right eye's medial wall. The patient underwent a joint operation with an ophthalmologist to remove the median orbital tumor by transnasal endoscopic orbital surgery. Anatomical pathology examination of the tumor tissue identified hemangiomas.

CONCLUSION

An endoscopic transnasal approach is a safe and effective way to access and manage an orbital tumor medial to the optic nerve. It is essential to have a multidisciplinary team with experience in endoscopic procedures. This patient had satisfactory results at their three-month postoperative follow-up. They reported no symptoms, and their CT scan did not show a relapsed mass in the right oculi region.

Successful Late Treatment of Orbital Infantile Haemangiomas in Two Teenagers with Topical Transcutaneous Timolol Maleate 0.5% Alone

We previously described the first successful treatment of deep periocular and, subsequently, orbital infantile haemangiomas (IH) with topical transcutaneous timolol maleate 0.5% (TM 0.5%) alone as the first-line treatment in the acute proliferative phase in infancy. It is not known whether orbital IH with persistent proptosis in later years, untreated in infancy, would still respond to TM 0.5% treatment as well. To our best knowledge, we here present the first reports of the successful late treatment of persistent orbital IH with topical timolol maleate 0.5% applied to the skin overlying the orbital IH in two teenagers. Case 1 was an 11-year-old girl with proptosis measuring 4 mm before and 7 mm after Valsalva manoeuvre that diminished to 1 mm after topical treatment. Case 2 was a 10-year-old girl with 2 mm (before) and 4 mm proptosis (after Valsalva) that decreased to 0 mm proptosis with topical treatment. The time to resolution was 19 months (case 1) and 13 months (case 2). The treatment dose was 3 drops of TM 0.5% applied an average of 1.94 (case 1) and two times daily (case 2). In comparison to proptosis, resolution of periorbital swelling required less treatment time. There was no recurrence of either proptosis or periorbital swelling 1 year after stopping treatment in either case. The findings indicate that beta-blockers are effective not just in the proliferative but also in the late involutional phase in older children. No adverse clinical effects were noted throughout treatment in either case. The presence of increased proptosis with a Valsalva manoeuvre predicts a significant persistent vascular compartment in the orbital IH and may thus serve as a simple predictive clinical sign of likely treatment success. We recommend that a trial with this well-tolerated treatment form is considered in persistent cases of orbital IH, especially in the presence of enhanced proptosis with a Valsalva manoeuvre.

Machine Learning Based Non-Enhanced CT Radiomics for the Identification of Orbital Cavernous Venous Malformations: An Innovative Tool

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.

Topical Timolol for Infantile Haemangioma of the Orbit

Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.