Infraorbital approach for retrobulbar orbital neurofibroma: a case report

<p class="abstract">Retrobulbar orbital tumours are rare and treatment is challenging. These tumors include cavernous hemangioma, neurofibroma, A-V malformations, glioma etc. A variety of approaches have been used in resection of these tumours. The various approaches in literature include endoscopic transethmoidal and sphenoidal, lateral orbitotomy, transmaxillary infraorbital, and cranial and sub cranial approaches. Such tumours located inferior to the optic nerve can be reached through infraorbital approach avoiding traction on optic nerve or pressure on globe. We are reporting a retrobulbar orbital neurofibroma in a middle aged lady who presented with unilateral loss of vision, episodic giddiness, severe left sided headache, left orbital pain and epiphora on exposure to sunlight. MRI showed well defined 1.8×1.8×1.7 cm enhancing lobulated solid left intraorbital mass extending along the substance of inferior aspect of left optic nerve with mass effect. With transmaxillary infraorbital endoscope assisted approach, the retrobulbar tumor was exposed and enucleated. Floor of orbit was reconstructed with tensor fascia lata and nasal septal cartilage graft. The patient had uneventful recovery and immediate post operative visual acuity was perception of light and likely to improve further. Histopathology revealed neurofibroma. This case report highlights the advantages of infraorbital approach as it is a simple approach along the suture lines through the orbital floor with the help of endoscopic guidance. It has the advantages of avoiding traction on optic nerve or optic chiasma, no retraction of brain, no communication with cranial cavity, no pressure on globe and easy reconstruction of orbital floor.</p>

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Transmaxillary Approach to the Orbit: An Anatomic Study

Neurosurgery ◽

10.1227/01.neu.0000084164.22028.10 ◽

2003 ◽

Vol 53 (4) ◽

pp. 935-942 ◽

Cited By ~ 19

Author(s):

Engin Gönül ◽

Ersin Erdogan ◽

Bulent Düz ◽

Erdener Timurkaynak

Keyword(s):

Optic Nerve ◽

Infraorbital Nerve ◽

Orbital Floor ◽

Anatomic Study ◽

Orbital Surgery ◽

Inferior Aspect ◽

Extradural Approach ◽

Brain Retraction ◽

Standard Techniques

Abstract OBJECTIVE Various approaches to expose the orbit have been used, such as cranial, lateral, and medial approaches. In an effort to gain exposure to the orbit without necessitating a craniotomy, we have developed a transmaxillary approach to the orbit. METHODS An approach was developed that uses data obtained by performing 24 orbit dissections in 12 cadaveric heads. After sublabial incision to expose the maxilla, maxillotomy is performed and the course of the infraorbital nerve is identified. The orbital floor is opened, and the orbit is accessed. RESULTS This technique offers access to the inferomedial and inferolateral orbit and to the inferior aspect of the optic nerve. CONCLUSION The transmaxillary approach provides an entirely extradural approach to the orbit. This technique combines the benefits of a cosmetically acceptable approach with orbitotomy and avoids the use of craniotomy and brain retraction to access the deep medial, lateral, and inferior orbit. We advocate the transmaxillary approach to the orbit in cases of inferomedial posterior intraconal and inferolateral lesions as an alternative and adjunct to the standard techniques of orbital surgery.

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Blindness due to unrecognized bilateral optic nerve sheath meningioma in a 14-year-old girl (case report)

Neuropediatrics ◽

10.1055/s-0030-1265603 ◽

2010 ◽

Vol 41 (02) ◽

Author(s):

M Pittner ◽

G Kammler ◽

H Zeumer ◽

A Schulz ◽

B Kruse ◽

...

Keyword(s):

Case Report ◽

Optic Nerve ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Optic Nerve Sheath Meningioma

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The Coexistence of Olfactory Groove with Optic Nerve Sheath Meningioma Presenting with Anosmia: Case Report

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616999201124123954 ◽

2020 ◽

Vol 16 ◽

Author(s):

Hatice Ferhan Kömürcü ◽

Gıyas Ayberk ◽

Ömer Anlar

Keyword(s):

Case Report ◽

Optic Nerve ◽

Visual Impairment ◽

Optic Nerve Sheath ◽

Olfactory Groove ◽

Nerve Sheath ◽

Optic Nerve Sheath Meningioma ◽

History Of ◽

Olfactory Groove Meningioma ◽

Memory Disturbance

Introduction: Meningiomas are the third most common intracranial tumors in adults after glial tumors and metastases. Olfactory groove meningiomas often grow without symptoms due to their slow growth rates and location in the frontal lobe. Optic nerve sheath meningiomas are benign neoplasms of the meninges surrounding the optic nerve. The coexistence of olfactory groove and optic nerve sheath meningiomas without any history of neurofibromatosis or radiotherapy has never been reported in the literature. Case Report: A 36-year-old female patient presenting with anosmia, headache, memory disturbance, and visual impairment and operated with the diagnosis of olfactory groove meningioma was reported. In the postoperative period, optic nerve sheath meningioma was detected in the imaging performed due to the persistence of visual impairment. Conclusion: Olfactory groove and optic nerve sheath meningiomas are rare tumors and can be diagnosed late because they progress slowly. Early diagnosis and treatment may affect the prognosis and morbidity of these patients favorably.

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Unilateral Optic Nerve Aplasia (ONA) in an otherwise Healthy Child: A Case Report and Literature Review

International Journal of Pharma and Bio Sciences ◽

10.22376/ijpbs.2018.9.1.b151-154 ◽

2018 ◽

Vol 9 (1) ◽

Author(s):

HASHEM S. ALMARZOUKI ◽

OMAR A. ROZY ◽

WALEED M. ALKHURAIMI ◽

MUSAB A. ALSUBAIE

Keyword(s):

Case Report ◽

Optic Nerve ◽

Literature Review ◽

Healthy Child

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Novel in vivo depiction of optic nerves hemorrhages in child abuse: a 3D-SWI pilot study

Neuroradiology ◽

10.1007/s00234-020-02622-6 ◽

2021 ◽

Author(s):

Giulio Zuccoli

Keyword(s):

Optic Nerve ◽

Mass Effect ◽

Abusive Head Trauma ◽

Superficial Siderosis ◽

Susceptibility Artifacts ◽

Female Ratio ◽

Optic Nerves ◽

Statistical Correlations ◽

Post Traumatic

Abstract Purpose Until now, the diagnosis of optic nerves hemorrhages in abusive head trauma (AHT) has been obtained only in the postmortem setting. The aim of the IRB-approved study was to assess the presence of optic nerves hemorrhages in AHT patients using 3D-SWI. Methods Thirteen children with a final confirmed multidisciplinary diagnosis of AHT underwent coronal and axial 3D-SWI imaging of the orbits. The presence of optic nerve sheath (ONS) hemorrhages was defined by thickening and marked 3D-SWI hypointensity of the ONS, resulting in mass effect upon the CSF space. Optic nerve (ON) hemorrhages were defined by areas of susceptibility artifacts in the ON parenchyma. Superficial siderosis was defined by susceptibility artifact coating the ON. Furthermore, data about post-traumatic deformity of the ONS at the head of the optic nerve were collected. Results The average age of the population was 7.9 ± 5.9 months old. The average GCS was 11.8 ± 4.5. The male to female ratio was 7:6. ONS hemorrhages were identified in 69.2% of cases. Superficial siderosis and ON hemorrhages were identified in 38.5 and 76.9% of cases, respectively. 3D-SWI also depicted traumatic deformity of the ONS at the level of the optic nerve head in 10 cases (76.9%). No statistical correlations were identified between RetCam findings and 3D-SWI findings or GCS and ON hemorrhages. Conclusion This research shows that dedicated MRI with volumetric SWI of the orbits can depict hemorrhages in the ON, ONS, and ONS injury, in AHT victims.

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Transpalpebral Superolateral Orbitotomy for Orbital Cavernous Hemangioma Extirpation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa389 ◽

2021 ◽

Vol 20 (4) ◽

pp. E300-E300

Author(s):

Adrien T May ◽

Ramona Guatta ◽

Torstein R Meling

Keyword(s):

Optic Nerve ◽

Cavernous Hemangioma ◽

Healthy Woman ◽

Mass Effect ◽

Complete Information ◽

Nerve Compression ◽

Definitive Treatment ◽

Vascular Tumors ◽

Cerebral Magnetic Resonance Imaging ◽

Patient Consent

Abstract Cavernous hemangiomas of the orbit are low-pressure vascular tumors. Usually benign, they become symptomatic by the local mass effect, pushing the eyeball forward, causing exophthalmia, by oculomotor muscle and nerve compression causing diplopia or by optic nerve compression, leading to visual impairment. Radiotherapy is of limited value in their treatment because of the fragility of the optic nerve and subsequent blindness risk. Surgery remains the gold standard and definitive treatment. We illustrate in this video a transpalpebral superolateral orbitotomy and extirpation of an orbital cavernous hemangioma. A 52-yr-old healthy woman was sent for neurosurgical consultation by her ophthalmologist. She described a history of progressive unilateral right exophthalmia in the last months. A cerebral magnetic resonance imaging (MRI) revealed a 2.5-cm-large orbital lesion located superiorly and laterally to the eyeball. Surgery was proposed and accepted by the patient. The frontozygomatic component of the orbital rim needed to be removed to safely extirpate the cavernous hemangioma without exerting unnecessary and risky pressure on the eyeball.1,2 We decided to go for a superolateral orbitotomy via a transpalpebral incision.3 Total removal of the lesion was achieved with no complication. Exophthalmia normalized. Written patient consent was obtained for use and publication of their image after complete information. The patient consented to the surgery.

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