1
|
Khan RI, McElhinney K, Dickson A, Kileen RP, Murphy C, O'Brien DF. Image-guided orbital surgery: a preclinical validation study using a high-resolution physical model. BMJ Open Ophthalmol 2024; 9:e001568. [PMID: 38575345 PMCID: PMC11002346 DOI: 10.1136/bmjophth-2023-001568] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/23/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE Preclinical validation study to assess the feasibility and accuracy of electromagnetic image-guided systems (EM-IGS) in orbital surgery using high-fidelity physical orbital anatomy simulators. METHODS EM-IGS platform, clinical software, navigation instruments and reference system (StealthStation S8, Medtronic) were evaluated in a mock operating theatre at the Royal Victoria Eye and Ear Hospital, a tertiary academic hospital in Dublin, Ireland. Five high-resolution 3D-printed model skulls were created using CT scans of five anonymised patients with an orbital tumour that previously had a successful orbital biopsy or excision. The ability of ophthalmic surgeons to achieve satisfactory system registration in each model was assessed. Subsequently, navigational accuracy was recorded using defined anatomical landmarks as ground truth. Qualitative feedback on the system was also attained. RESULTS Three independent surgeons participated in the study, one junior trainee, one fellow and one consultant. Across models, more senior participants were able to achieve a smaller system-generated registration error in a fewer number of attempts. When assessing navigational accuracy, submillimetre accuracy was achieved for the majority of points (16 landmarks per model, per participant). Qualitative surgeon feedback suggested acceptability of the technology, although interference from mobile phones near the operative field was noted. CONCLUSION This study suggests the feasibility and accuracy of EM-IGS in a preclinical validation study for orbital surgery using patient specific 3D-printed skulls. This preclinical study provides the foundation for clinical studies to explore the safety and effectiveness of this technology.
Collapse
Affiliation(s)
- Rizwana I Khan
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Andrew Dickson
- School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
| | - Ronan P Kileen
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Conor Murphy
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Donncha F O'Brien
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
2
|
Ayoub E, Farid A, Yahya C, Nizar EB, Meryem H, Youssef LAM, Meriem B, Maâroufi M, Badreeddine A. Cavernous hemangioma of the orbit: Case report and a review of the literature. Radiol Case Rep 2022; 17:4104-4107. [PMID: 36065249 PMCID: PMC9439960 DOI: 10.1016/j.radcr.2022.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ettabyaoui Ayoub
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
- Department of Radiology and Clinical Imaging, Faculty of Medicine and Pharmacy, University of Fez, BP. 1893; Km 2.200, Sidi Hrazem Road, Fes 30000, Morocco
- Corresponding author.
| | - Aassouani Farid
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Charifi Yahya
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - El Bouardi Nizar
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Haloua Meryem
- Department of Radiology Mother and Child and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Lamrani Alaoui My Youssef
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Boubbou Meriem
- Department of Radiology Mother and Child and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Mustapha Maâroufi
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Alami Badreeddine
- Department of Radiology and Interventional Imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| |
Collapse
|
3
|
Fabozzi GL, d’Avella E, Burroni M, Romano A, Cavallo LM, Solari D. Endoscopic transorbital eyelid approach for the removal of an extraconal cavernous venous malformation: Case report. Front Surg 2022; 9:954530. [PMID: 35937596 PMCID: PMC9349361 DOI: 10.3389/fsurg.2022.954530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Cavernous venous malformations (CVMs) are one of the most common benign primary orbital lesions in adults and the second most frequent cause of unilateral proptosis. Extraconal location is extremely rare, representing a favorable condition as compared to intraconal, as lesions at this level often adhere to orbital muscles and optic nerve. Herein, we report the case of a 50-year-old patient, who came to our attention because of progressive painless right axial proptosis. Magnetic resonance images were consistent with an extraconal CVM, occupying the superior temporal compartment of the orbit. Successful removal of the lesion was achieved through an endoscopic transorbital eyelid approach. The present case confirms the safety and efficacy of the endoscopic transorbital eyelid approach.
Collapse
Affiliation(s)
- Gianluca Lorenzo Fabozzi
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Elena d’Avella
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
- Correspondence: Elena d’Avella
| | - Matias Burroni
- Department of Neurosurgery, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Antonio Romano
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Maxillofacial Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Domenico Solari
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| |
Collapse
|
4
|
Zhou G, Pan Z, Tu Y, Yu B, Shi J, Wu E, Wu W. Removal of Small Cavernous Hemangioma in Orbital Apex Through an Endoscopic Transethmoidal-Sphenoidal Approach. Laryngoscope 2022; 132:1743-1749. [PMID: 35385151 DOI: 10.1002/lary.30131] [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: 12/23/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the feasibility, efficacy, and safety of an endoscopic transethmoidal-sphenoidal approach in removing a small cavernous hemangioma (CH) located in the deep lateral orbital apex. METHODS This study involved 19 patients diagnosed with a CH located in the deep lateral orbital apex. All patients underwent an endoscopic transethmoidal-sphenoidal approach for removal of the CH. The best-corrected visual acuity (BCVA), visual field, and surgery-related complications were analyzed and compared. RESULTS All tumors in this study were completely removed. The mean BCVA was LogMAR 0.97 ± 0.97 preoperatively and LogMAR 0.38 ± 0.64 postoperatively (p < 0.05). The mean visual field index was 52.26% ± 33.26% preoperatively and 75.47% ± 30.49% postoperatively (p < 0.05). The mean deviation index was -17.48 ± 12.43 dB preoperatively and -10.10 ± 10.85 dB postoperatively (p < 0.05), and the pattern standard deviation was 6.37 ± 3.77 dB preoperatively and 4.90 ± 3.56 dB postoperatively (p > 0.05). Four (21.1%) patients developed oculomotor limitations and two (10.5%) patients developed ptosis after surgery. All of these symptoms resolved spontaneously, and no other complications occurred. The mean follow-up time was 6.71 ± 3.89 months. CONCLUSION The endoscopic transethmoidal-sphenoidal approach is an effective and minimally invasive treatment for removing small CH in the deep lateral orbital apex. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2022.
Collapse
Affiliation(s)
- Guangming Zhou
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Zhaoqi Pan
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Yunhai Tu
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Bo Yu
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Jieliang Shi
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Ende Wu
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Wencan Wu
- The Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| |
Collapse
|
5
|
Abstract
PURPOSE Vascular anomalies are a heterogeneous group of disorders that frequently present in the periorbital region. They encompass 2 broad entities: vascular tumors, which possess a proliferative endothelium, and vascular malformations, which are basically localized defects of vascular morphogenesis. The primary goal of this review was to address inaccurate or controversial terminology in the oculoplastic literature concerning orbital and periorbital vascular anomalies and to categorize these lesions in an abridged and simplified hierarchical list that adheres as much as possible to the most recent (2018) iteration for the classification of vascular lesions proposed by the International Society for the Study of Vascular Anomalies (ISSVA). The secondary goal of this review was to review and update information regarding the genetic underpinnings of vascular anomalies and the downstream signaling pathways that are subsequently affected as a result of these genetic errors. METHODS A literature review was conducted in PubMed, MEDLINE, PubMed Central, National Center for Biotechnology Information Bookshelf, and Embase for several related keywords including "vascular anomalies, vascular malformations, vascular tumors, and cavernous venous malformation," both with and without adding the keywords "eyelid," "orbital," and "periorbital." In addition, a detailed search was conducted for controversial or obsolete keywords like "cavernous hemangioma," "lymphangioma," and "varices," again in their systemic and orbital/periorbital context. RESULTS Crucial issues in the 2018 ISSVA classification regarding the proper categorization of orbital vascular anomalies, particularly venous lesions, were critically evaluated and revised, and a regional, simplified, and abridged modification of the ISSVA 2018 classification was proposed. CONCLUSIONS Interdisciplinary and intradisciplinary dialogue concerning orbital vascular anomalies is seriously compromised due to the lack of a unanimous agreement on terminology and the absence of a unified classification concept system. The authors recommend that oculoplastic surgeons adopt ISSVA terminology whenever technically possible and scientifically sound. However, they also propose modifying the ISSVA 2018 classification specifically to adapt to the peculiarities of vascular anomalies in the periorbital region. At present, the simplified classification proposed here is a preliminary first step towards managing patients with orbital vascular anomalies with greater diagnostic and therapeutic precision, until such time in the future when the entire genetic makeup of orbital vascular anomalies is more completely elucidated. Optimistically, this could pave the way for a more robust classification and the ultimate therapeutic cure.
Collapse
Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
6
|
Li Y, Yang J, Huang Y, Ge S, Song X, Jia R, Wang Y. Cellular heterogeneity and immune microenvironment revealed by single-cell transcriptome in venous malformation and cavernous venous malformation. J Mol Cell Cardiol 2021; 162:130-143. [PMID: 34536440 DOI: 10.1016/j.yjmcc.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
Venous malformation (VM) and cavernous venous malformation (CVM) are two types of vascular malformations. Even if the two diseases are similar in appearance and imaging, the distinct cellular components and signaling pathways between them might help distinguish the two from a molecular perspective. Here, we performed single-cell profiling of 35,245 cells from two VM samples and three CVM samples, with a focus on endothelial cells (ECs), smooth muscle cells (SMCs) and immune microenvironment (IME). Clustering analysis based on differential gene expression unveiled 11 specific cell types, and determined CVM had more SMCs. Re-clustering of ECs and SMCs indicated CVM was dominated by arterial components, while VM is dominated by venous components. Gene set variation analysis suggested the activation of inflammation-related pathways in VM ECs, and upregulation of myogenesis pathway in CVM SMCs. In IME analysis, immune cells were identified to accounted for nearly 30% of the total cell number, including macrophages, monocytes, NK cells, T cells and B cells. Notably, more macrophages and monocytes were discovered in VM, indicating innate immune responses might be more closely related to VM pathogenesis. In addition, angiogenesis pathway was highlighted among the significant pathways of macrophages & monocytes between CVM and VM. In VM, VEGFA was highly expressed in macrophages & monocytes, while its receptors were all abundantly present in ECs. The close interaction of VEGFA on macrophages with its receptors on ECs was also predicted by CellPhoneDB analysis. Our results document cellular composition, significant pathways, and critical IME in CVM and VM development.
Collapse
Affiliation(s)
- Yongyun Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Yang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yazhuo Huang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| |
Collapse
|
7
|
Abstract
Historically, surgical access to orbital tumors has required a transcutaneous, transconjunctival or transcranial approach. Resection of orbital tumors is notoriously challenging due to the surrounding dense network of critical structures in a confined bony cavity. Advances in endoscopic endonasal surgery, initially used for sinonasal and skull base conditions, have allowed for expansion of its applications beyond the sinorbital interface. In the past decade, the evolution of techniques has enabled a purely endoscopic, minimally invasive approach to medially located orbital pathology with good outcomes. With experience and multidisciplinary collaboration between orbit and rhinologic surgeons, this has expanded to allow for a safe and effective transnasal approach to nearly all regions of the orbit with or without assistance from the orbital side. This review summarizes the relevant anatomy, variations of surgical approaches, and literature regarding outcomes of the endoscopic endonasal approach to orbital tumors.
Collapse
Affiliation(s)
- Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Rajkarnikar Sthapit P, Sayami G, Saiju R. Multiple Cavernous Haemangioma of Orbit and Cranium: A Case Report. ACTA ACUST UNITED AC 2021; 59:74-76. [PMID: 34508450 PMCID: PMC7893390 DOI: 10.31729/jnma.5606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Indexed: 11/25/2022]
Abstract
A 32-year-old male presented with painless proptosis and diminution of vision in left eye. Imaging shows multiple well-defined masses, suggestive of cavernous haemangioma, in orbit and cranium with adjoining bones being thickened with cystic spaces. Histopathology proved the diagnosis. Cavernous haemangioma usually presents as a solitary intraconal and sometimes extraconal mass with vision usually preserved unless it extends to the apical portion. Here we report a rare case of multiple simultaneous locations of cavernous haemangiomas in orbit and cranium with significant diminution of vision.
Collapse
Affiliation(s)
| | - Gita Sayami
- Department of Pathology, HAMS Hospital, Kathmandu, Nepal
| | - Rohit Saiju
- Department of Oculoplasty and Ocular Oncology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| |
Collapse
|
9
|
Abstract
Orbital hemangiomas are the most common primary neoplasm of the orbit and manifest as two distinct pathologic entities: infantile hemangiomas and cavernous hemangiomas. In this article, both infantile and cavernous hemangiomas are reviewed, with special attention paid to the natural history, clinical presentation, and management teams and approaches involved. An example case of each type of hemangioma is presented along with pearls and tips a reader can take away after reading this article.
Collapse
Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
10
|
Sa HS, Rubin ML, Ning J, Li W, Tetzlaff MT, McGovern SL, Paulino AC, Herzog CE, Gill JB, Esmaeli B. Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma. JAMA Ophthalmol 2020; 138:374-381. [PMID: 32105303 DOI: 10.1001/jamaophthalmol.2020.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance No previous studies to date have validated the American Joint Committee on Cancer (AJCC) 8th edition of the TNM classification for orbital sarcoma. Objectives To determine the prognostic performance of the most recent TNM classification for orbital sarcoma and to identify other prognostic factors for local recurrence, lymph node metastasis, distant metastasis, and death due to disease. Design, Setting, and Participants This single-center retrospective cohort study included 73 consecutive patients treated for orbital sarcoma from March 1, 2003, through June 30, 2018. Data were analyzed from November 1 to December 31, 2018. Main Outcomes and Measures T and N categories at presentation and disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis (DM), and death due to disease (DD). Results The 73 participants included 43 men (59%), and the median age was 21 (range, 0-77) years. The common histologic types were rhabdomyosarcoma (RMS) (35 [48%]), solitary fibrous tumor/hemangiopericytoma (10 [14%]), and Ewing sarcoma (8 [11%]). The most common TNM designations were T2 N0 M0 (26 [36%]) and T4 N0 M0 (24 [33%]). T category was associated with the risk of all disease-related outcomes, including local recurrence (hazard ratio [HR] for T2 vs T4, 0.22 [95% CI, 0.06-0.81]; HR for T3 vs T4, 0.59 [95% CI, 0.13-2.65]; P = .03), lymph node metastasis by the last follow-up (T1, 1 [14%]; T2, 0; T3, 0; T4, 12 [35%]; P = .001), DM (HR for T2 vs T4, 0.29 [95% CI, 0.08-1.07]; P = .04), and DD (HR of T2 vs T4, 0.16 [95% CI, 0.04-0.73]; HR of T3 vs T4, 0.30 [95% CI, 0.04-2.34]; P = .02). Higher risk of DM and higher risk of DD were associated with disease category of at least T3 (HR for DM, 3.24 [95% CI, 0.89-11.72; P = .06]; HR for DD, 6.32 [95% CI, 1.43-27.95; P = .005]), N1 disease (HR for DM, 13.33 [95% CI, 4.07-43.65; P < .001]; HR for DD, 7.07 [95% CI, 2.45-20.44; P < .001]), tumor size larger than 3 cm (HR for DM, 2.72 [95% CI, 0.92-8.05; P = .06]; HR for DD, 5.79 [95% CI, 1.85-18.14; P < .001]), and age of patient with RMS younger than 1 year or 10 years or older (HR for DM, 6.85 [95% CI, 0.83-56.53; P = .04]; HR for DD, 7.03 [95% CI, 0.85-57.83; P = .04]). Higher risk of local recurrence was associated with disease category of at least T3 (HR for<T3 vs≥T3, 0.20 [95% CI, 0.06-0.71]; P < .01) and tumor size greater than 3 cm (HR for ≤3 cm vs >3 cm, 0.27 [95% CI, 0.09-0.77]; P = .009). Higher risk of lymph node metastasis was associated with disease category of at least T3 (odds ratio [OR], 13.33 [95% CI, 1.77-602.30]; P = .004), alveolar RMS (OR, 9.98 [95% CI, 2.13-51.55]; P = .001), and age of patient with RMS younger than 1 year or 10 years or older (OR, 9.20 [95% CI, 1.01-458.29] P = .03). Conclusions and Relevance In patients with orbital sarcoma, T and N categories at presentation (defined by the AJCC 8th edition classification) correlate with metastasis and survival. These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with orbital sarcoma with disease category of at least T3 and/or N1 disease.
Collapse
Affiliation(s)
- Ho-Seok Sa
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Maria Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cynthia E Herzog
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jonathan B Gill
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
11
|
Boparai RS, Maeng MM, Dunbar KE, Godfrey KJ, Tooley AA, Maher M, Kazim M. Comparing Image Segmentation Techniques for Determining 3D Orbital Cavernous Hemangioma Size on MRI. Ophthalmic Plast Reconstr Surg 2020; 36:569-574. [DOI: 10.1097/iop.0000000000001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Bonavolontà P, Fossataro F, Attanasi F, Clemente L, Iuliano A, Bonavolontà G. Epidemiological Analysis of Venous Malformation of the Orbit. J Craniofac Surg 2020; 31:759-761. [PMID: 31842075 DOI: 10.1097/scs.0000000000006095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Orbital venous malformation (OVM) is one of the most common orbital mass of adults, accounting for approximately 5% to 15% of all vascular abnormalities in the central nervous system and representing 9% of orbital lesions. Clinical presentation is variable from asymptomatic cases to symptomatic ones. The purpose of the authors' work is to analyze OVM incidence and prevalence in a cohort of patients referred over the last 40 years to the Orbital Unit, tertiary center for orbital diseases.Records of 224 patients diagnosed with CVM in a 40-year period were retrospectively reviewed extracting prevalence/year and incidence/year based on data obtained from Eurostat population statistics. Data were aggregate and analyzed with a Microsoft Excel (Microsoft Corporation, Redmond, WA) spread sheet.The incidence rate was measured as the number of new cases of OVM observed in Orbital Unit, a tertiary center. Incidence was about 1 case out (0.94) every 10 million people. The incidence rate was measured also as the number of new cases of OVM observed in Campania, considering in the latter case patients residents in this region (112 patients). Incidence was less than 1 case out (0.58) every 10 million people.The prevalence rate was measured as the proportion of individuals with OVM observed in our Orbital Unit and is equal to 5%. This indicator resulted to increase from 1977 to 2017.The management of OVM is still under discussion, but in agreement with data present in the literature the authors still believe that the surgical indication is only for symptomatic lesions.
Collapse
Affiliation(s)
- Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II
| | - Federica Fossataro
- Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples
| | - Federica Attanasi
- Department of Statistical Sciences, University La Sapienza, Rome, Italy
| | - Lidia Clemente
- Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples
| | - Adriana Iuliano
- Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples
| | - Giulio Bonavolontà
- Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples
| |
Collapse
|
13
|
Bagheri A, Feizi M, Tavakoli M. Unusual Subcutaneous Presentation of Cavernous Hemangioma in the Lower Eyelid. J Ophthalmic Vis Res 2020; 15:236-239. [PMID: 32308958 PMCID: PMC7151512 DOI: 10.18502/jovr.v15i2.6741] [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: 04/06/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a patient with cavernous hemangioma (CH) presenting as a "subcutaneous" lower eyelid mass. Case report A 37-year-old man presented with a painless and palpable mass over the right lower eyelid for two years prior to referral. Computed tomography scan revealed a well-defined, lobulated mass located in the mid and lateral portion of the lower eyelid that extended posteriorly to the anterior orbital space. A transcutaneous excisional biopsy was performed. Histopathologic findings of the tumor confirmed CH. Most CHs are intraconal lesions, making our case an unusual presentation for this condition. Conclusion Purpose Case report CH may present superficially in the eyelid and anterior orbital area and thus, although this location is not common, it should be kept in mind as a differential diagnosis for any well-defined eyelid tumor.
Collapse
Affiliation(s)
- Abbas Bagheri
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, The University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, Al, USA
| |
Collapse
|
14
|
Kim MH, Kim JH, Kim SE, Yang SW. Surgical Outcomes of Intraconal Cavernous Venous Malformation According to Their Location in Four Right-Angled Sectors. J Craniofac Surg 2019; 30:1700-5. [PMID: 30950949 DOI: 10.1097/SCS.0000000000005501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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
|
Ratnayake GS, McNab AA, Dally MJ, Zajarski C, Senthi S, Ruben JD. Fractionated Stereotactic Radiotherapy for Cavernous Venous Malformations of the Orbital Apex. Ophthalmic Plast Reconstr Surg 2019; 35:322-325. [PMID: 30365476 DOI: 10.1097/iop.0000000000001239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to investigate the efficacy and safety of fractionated stereotactic radiotherapy in the treatment of cavernous venous malformation of the orbital apex. METHODS The authors reviewed a prospective database from a single center of patients with cavernous venous malformation of the orbital apex who had treatment with fractionated stereotactic radiotherapy. The authors compared the symptoms, visual function and the size of the tumor pre- and posttreatment as well as reviewed the treatment details and the incidence of complications. RESULTS Six patients received treatment with fractionated stereotactic radiotherapy for cavernous venous malformation involving the orbital apex. The median age was 48 (range, 32-63), and 50% were female. Patients received a dose of 45 to 50.4 Gy in 1.8 to 2 Gy fractions. Median follow up was 33 months (range, 18-66 months). The average tumor volume reduction at posttreatment imaging after 12 months was 63%. All lesions reduced in size postradiotherapy and remained controlled for the duration of follow up. All patients who had proptosis or a visual field defect had an improvement in the symptoms posttreatment. There were no complications of the treatment. CONCLUSION Fractionated stereotactic radiotherapy appears to be a safe and effective management option for cavernous venous malformation of the orbital apex and leads to a sustained reduction of the volume of the lesion with associated improvement in symptoms and visual function.
Collapse
Affiliation(s)
| | - Alan A McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital
| | | | | | - Sashendra Senthi
- Alfred Health Radiation Oncology, The Alfred Hospital.,Monash University, Melbourne, Australia
| | - Jeremy D Ruben
- Alfred Health Radiation Oncology, The Alfred Hospital.,Monash University, Melbourne, Australia
| |
Collapse
|
16
|
Dzhindzhikhadze RS, Dreval' ON, Lazarev VA, Polyakov AV. [The transpalpebral keyhole approach in surgery of orbital cavernomas: a case report and literature review]. Zh Vopr Neirokhir Im 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
17
|
Lucarelli KM, Raven ML, Lucarelli MJ. Progressive Proptosis and Worsening Vision. JAMA Ophthalmol 2019; 137:312-313. [PMID: 30570651 DOI: 10.1001/jamaophthalmol.2018.5024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Meisha L Raven
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
| | - Mark J Lucarelli
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
| |
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
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.
Collapse
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
| |
Collapse
|
20
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
21
|
Honavar SG, Manjandavida FP. Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016. Asia Pac J Ophthalmol (Phila) 2017; 6:153-158. [PMID: 28399335 DOI: 10.22608/apo.201736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this review article is to provide an update of the current literature on orbital tumors. The authors conducted a PubMed literature search of English language articles published between January 2014 and December 2016 using the following search items: orbit, tumors, lacrimal gland, lymphoma, hemangioma, lymphangioma. The authors included reviews, original articles, case series, and case reports with relevant new information. There is new information about the clinical spectrum of orbital tumors, capillary hemangioma, cavernous hemangioma, lymphangioma, orbital venous malformation, lacrimal gland tumors, and orbital lymphoma. This review highlights the current understanding, practice, and guidelines in the diagnosis and management of common tumors of the orbit.
Collapse
Affiliation(s)
- Santosh G Honavar
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Center for Sight, Hyderabad
| | - Fairooz P Manjandavida
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, HORUS Specialty Eye Care, Bangalore, India
| |
Collapse
|
22
|
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: 65] [Impact Index Per Article: 9.3] [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: 05/10/2016] [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
|
23
|
Chen Y, Tu Y, Chen B, Shi J, Yu B, Wu W. Endoscopic Transnasal Removal of Cavernous Hemangiomas of the Optic Canal. Am J Ophthalmol 2017; 173:1-6. [PMID: 27670622 DOI: 10.1016/j.ajo.2016.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the feasibility and efficacy of endoscopic transnasal removal of cavernous hemangiomas of the optic canal. DESIGN Retrospective, noncomparative case series. METHODS Eleven consecutive patients (11 eyes) with cavernous hemangioma of the optic canal underwent endoscopic trans-ethmoidal-sphenoidal removal of the tumor at the Eye Hospital of Wenzhou Medical University from January 2009 to March 2016. In each case, the indication for surgery was decreased visual acuity due to the tumor. The removal was believed to be complete if the tumor was removed en bloc during the surgery. A mucoperiosteal flap was used to cover the defect in the optic nerve sheath after tumor removal. The tumor was pathologically confirmed to be cavernous hemangioma after surgery. The mean follow-up time was 9.9 ± 5.5 months. Visual acuity before and after surgery was compared. RESULTS All tumors were completely removed by the endoscopic approach. The best-corrected visual acuity (BCVA) improved after surgery in all patients. The mean preoperative BCVA was 6/30 (95% confidence interval [CI] 6/60-6/20) and the mean postoperative BCVA was 6/10 (95% CI 6/12-6/7.5). All patients showed cerebrospinal fluid rhinorrhea, which resolved with strict bed rest. Other complications included hyposmia in 2 patients; nasal bleeding in 3 patients, which resolved spontaneously; and temporary headache. CONCLUSIONS Endoscopic trans-ethmoidal-sphenoidal approach is a feasible option for cavernous hemangiomas of the optic canal.
Collapse
|
24
|
Bleier BS, Castelnuovo P, Battaglia P, Turri-Zanoni M, Dallan I, Metson R, Sedaghat AR, Stefko ST, Gardner PA, Snyderman CH, Nogueira JF, Ramakrishnan VR, Muscatello L, Lenzi R, Freitag S. Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes. Int Forum Allergy Rhinol 2015; 6:156-61. [PMID: 26623968 DOI: 10.1002/alr.21645] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 07/07/2015] [Revised: 07/28/2015] [Accepted: 08/11/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endoscopic orbital surgery represents the next frontier in endonasal surgery. The current literature is largely composed of small, heterogeneous, case series with little consensus regarding optimal techniques. The purpose of this study was to combine the experience of multiple international centers to create a composite of the global experience on the endoscopic management of a single type of tumor, the orbital cavernous hemangioma (OCH). METHODS This was a retrospective study of techniques for endoscopic OCH resection from 6 centers on 3 continents. Only primary data from strictly endoscopic resection of OCHs were included. Responses were analyzed to qualitatively identify points of both consensus and variability among the different groups. RESULTS Data for a total of 23 patients, 10 (43.5%) male and 13 (56.5%) female were collected. The majority of lesions were intraconal (60.9%). The mean ± standard deviation (SD) surgical time was 150.7 ± 75.0 minutes with a mean blood loss of 82.7 ± 49.6 mL. Binarial approaches (26.1%) were used exclusively in the setting of intraconal lesions, which were associated with a higher rate of incomplete resection (31.3%), postoperative diplopia (25.0%), and the need for reconstruction (37.5%) than extraconal lesions. Orthotropia and symmetric orbital appearance were achieved in 60.9% and 78.3% of cases, respectively. CONCLUSION Extraconal lesions were managed similarly; however, greater variability was evident for intraconal lesions. These included the laterality and number of hands in the approach, methods of medial rectus retraction, and the need for reconstruction. The increased technical complexity and disparity of techniques in addressing intraconal OCHs suggests that continued research into the optimal management of this subclass of lesions is of significant priority.
Collapse
Affiliation(s)
- Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Paolo Castelnuovo
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Iacopo Dallan
- Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Ralph Metson
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Carl H Snyderman
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Luca Muscatello
- Division of Otorhinolaryngology, General Hospital of Massa, Massa, Italy
| | - Riccardo Lenzi
- Division of Otorhinolaryngology, General Hospital of Massa, Massa, Italy
| | - Suzanne Freitag
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| |
Collapse
|