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Huge cavernous hemangiomas enveloping the optic nerve successfully removed by a vertical lid split orbitotomy.

Yum JH, Kim YD, Lee JH, Woo KI - Case Rep Ophthalmol Med (2014)

Bottom Line: Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy.Histopathologic examination confirmed the diagnosis of cavernous hemangioma.The patient achieved a satisfactory cosmetic outcome 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Republic of Korea.

ABSTRACT
A 63-year-old woman presented with a 15-year history of gradually increasing proptosis of right eye. Ocular examination revealed proptosis of 9 mm with decreased visual acuity in her right eye. CT scan showed a well-circumscribed and enhancing orbital mass filling almost the entire right orbit. The tumor occupied the superolateral, superomedial, and inferomedial intraconal space, enveloping the optic nerve. Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy. Histopathologic examination confirmed the diagnosis of cavernous hemangioma. There were no intraoperative or postoperative complications. The patient achieved a satisfactory cosmetic outcome 1 year after surgery.

No MeSH data available.


Related in: MedlinePlus

(a) Preoperative clinical photography shows the significant proptosis and inferolateral displacement of right eye. (b) CT scan of initial presentation shows well-demarcated enhancing intraconal vascular tumor in the right orbit. (c) 14 years later, MRI showing hypointense masses on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrating dense contrast enhancement. The optic nerve is surrounded and compressed by tumor (black arrow).
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fig1: (a) Preoperative clinical photography shows the significant proptosis and inferolateral displacement of right eye. (b) CT scan of initial presentation shows well-demarcated enhancing intraconal vascular tumor in the right orbit. (c) 14 years later, MRI showing hypointense masses on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrating dense contrast enhancement. The optic nerve is surrounded and compressed by tumor (black arrow).

Mentions: A 63-year-old female presented to our clinic with a painless and prominent right eye of 15 years duration (Figure 1(a)). When she first presented to us 14 years ago, she had no significant past medical history of note. Her visual acuity was 20/20 in both eyes. Hertel exophthalmometry measurement was 13.5 mm in the right eye and 10 mm in the left eye. Computed tomography (CT) scan showed well-demarcated, enhancing intraconal vascular tumor surrounding the optic nerve in the right orbit. After that time, she was lost to follow up. Two years ago, she revisited our clinic with progressive visual disturbance in her right eye. On ophthalmic examination, best corrected visual acuity was 20/200 OD and 20/20 OS. Hertel ophthalmometry revealed 9 mm proptosis of the right eye. There was a relative afferent pupillary defect and a color vision defect in the right eye. On fundus examination, she had mild elevation of the right optic disc. Goldmann visual field demonstrated a central and temporal scotoma of the right eye. Visual evoked potential (VEP) showed delay in P100 and decreased amplitude in the right eye. CT scan showed that the tumor occupied the superolateral, superomedial, and inferomedial intraconal spaces, enveloping the optic nerve and displaced the globe anteriorly and inferolaterally. The size of the tumor was larger as compared to 14 years ago (Figure 1(b)). MRI revealed the tumor was hypointense on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrated progressive filling on gadolinium enhanced sequences (Figure 1(c)). A vertical lid split orbitotomy was performed to remove the tumor. The larger tumor was firmly attached to the smaller tumor with fibrous band and the optic nerve was located between two tumors. Careful dissection was performed, so as not to damage the optic nerve. After all fibrous adhesions between two tumors were released, the larger tumor was removed successfully and then smaller tumor was removed safely. The lid incision was repaired with a similar method used for repair of a full thickness lid margin laceration. The masses measured 5 × 3 × 1 cm and 3 × 1 × 1 cm, respectively. Histopathologic examination confirmed the diagnosis of cavernous hemangiomas (Figure 2). There was no intraoperative complication, and the patient's recovery was uneventfully. At postoperative 6 months, best corrective visual acuity of the right eye was improved to 20/50. There was satisfactory cosmesis with no eyelid dysfunction. CT scan of the orbit showed no residual tumor in the orbit (Figure 3).


Huge cavernous hemangiomas enveloping the optic nerve successfully removed by a vertical lid split orbitotomy.

Yum JH, Kim YD, Lee JH, Woo KI - Case Rep Ophthalmol Med (2014)

(a) Preoperative clinical photography shows the significant proptosis and inferolateral displacement of right eye. (b) CT scan of initial presentation shows well-demarcated enhancing intraconal vascular tumor in the right orbit. (c) 14 years later, MRI showing hypointense masses on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrating dense contrast enhancement. The optic nerve is surrounded and compressed by tumor (black arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4020549&req=5

fig1: (a) Preoperative clinical photography shows the significant proptosis and inferolateral displacement of right eye. (b) CT scan of initial presentation shows well-demarcated enhancing intraconal vascular tumor in the right orbit. (c) 14 years later, MRI showing hypointense masses on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrating dense contrast enhancement. The optic nerve is surrounded and compressed by tumor (black arrow).
Mentions: A 63-year-old female presented to our clinic with a painless and prominent right eye of 15 years duration (Figure 1(a)). When she first presented to us 14 years ago, she had no significant past medical history of note. Her visual acuity was 20/20 in both eyes. Hertel exophthalmometry measurement was 13.5 mm in the right eye and 10 mm in the left eye. Computed tomography (CT) scan showed well-demarcated, enhancing intraconal vascular tumor surrounding the optic nerve in the right orbit. After that time, she was lost to follow up. Two years ago, she revisited our clinic with progressive visual disturbance in her right eye. On ophthalmic examination, best corrected visual acuity was 20/200 OD and 20/20 OS. Hertel ophthalmometry revealed 9 mm proptosis of the right eye. There was a relative afferent pupillary defect and a color vision defect in the right eye. On fundus examination, she had mild elevation of the right optic disc. Goldmann visual field demonstrated a central and temporal scotoma of the right eye. Visual evoked potential (VEP) showed delay in P100 and decreased amplitude in the right eye. CT scan showed that the tumor occupied the superolateral, superomedial, and inferomedial intraconal spaces, enveloping the optic nerve and displaced the globe anteriorly and inferolaterally. The size of the tumor was larger as compared to 14 years ago (Figure 1(b)). MRI revealed the tumor was hypointense on T1-weighted sequence and hyperintense on T2-weighted sequence and demonstrated progressive filling on gadolinium enhanced sequences (Figure 1(c)). A vertical lid split orbitotomy was performed to remove the tumor. The larger tumor was firmly attached to the smaller tumor with fibrous band and the optic nerve was located between two tumors. Careful dissection was performed, so as not to damage the optic nerve. After all fibrous adhesions between two tumors were released, the larger tumor was removed successfully and then smaller tumor was removed safely. The lid incision was repaired with a similar method used for repair of a full thickness lid margin laceration. The masses measured 5 × 3 × 1 cm and 3 × 1 × 1 cm, respectively. Histopathologic examination confirmed the diagnosis of cavernous hemangiomas (Figure 2). There was no intraoperative complication, and the patient's recovery was uneventfully. At postoperative 6 months, best corrective visual acuity of the right eye was improved to 20/50. There was satisfactory cosmesis with no eyelid dysfunction. CT scan of the orbit showed no residual tumor in the orbit (Figure 3).

Bottom Line: Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy.Histopathologic examination confirmed the diagnosis of cavernous hemangioma.The patient achieved a satisfactory cosmetic outcome 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Republic of Korea.

ABSTRACT
A 63-year-old woman presented with a 15-year history of gradually increasing proptosis of right eye. Ocular examination revealed proptosis of 9 mm with decreased visual acuity in her right eye. CT scan showed a well-circumscribed and enhancing orbital mass filling almost the entire right orbit. The tumor occupied the superolateral, superomedial, and inferomedial intraconal space, enveloping the optic nerve. Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy. Histopathologic examination confirmed the diagnosis of cavernous hemangioma. There were no intraoperative or postoperative complications. The patient achieved a satisfactory cosmetic outcome 1 year after surgery.

No MeSH data available.


Related in: MedlinePlus