scholarly journals Orbital Apex Cavernous Hemangioma Causing a Temporal Visual Field Deficit

Author(s):  
Ashley A Campbell
2021 ◽  
pp. 32-40
Author(s):  
Yusuke Murai ◽  
Takuji Kurimoto ◽  
Sotaro Mori ◽  
Kaori Ueda ◽  
Mari Sakamoto ◽  
...  

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient’s VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.


2012 ◽  
Vol 117 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Juri Kivelev ◽  
Elina Koskela ◽  
Kirsi Setälä ◽  
Mika Niemelä ◽  
Juha Hernesniemi

Object Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome. Methods Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years). Results All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up. Conclusions Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.


2010 ◽  
Vol 53 (02) ◽  
pp. 77-79 ◽  
Author(s):  
K. Yoshimura ◽  
S. Kubo ◽  
H. Yoneda ◽  
H. Hasegawa ◽  
S. Tominaga ◽  
...  

2019 ◽  
Vol 12 (2) ◽  
pp. 568
Author(s):  
E. Raffin

1993 ◽  
Vol 78 (6) ◽  
pp. 979-982 ◽  
Author(s):  
William Y. Lu ◽  
Marc Goldman ◽  
Byron Young ◽  
Daron G. Davis

✓ Gangliogliomas of the optic nerve are extremely rare. The case is reported of a 38-year-old man who presented with a visual field deficit and was discovered to have an optic nerve ganglioglioma. The possible embryological origins of this neoplasm, its histological and immunohistochemical features, and its appearance on magnetic resonance imaging are examined. The prognoses of optic nerve glioma and of gangliogliomas occurring elsewhere in the nervous system are compared.


2016 ◽  
Vol 30 (1) ◽  
pp. 47-51
Author(s):  
R.M. Gorgan ◽  
Angela Neacsu ◽  
Silvia Mara Baez Rodriguez ◽  
G. Popescu ◽  
Catioara Cristescu ◽  
...  

Abstract Schwannomas arise in the cells responsible for the mielinating the neurons distal to the Obersteiner-Redlich zone. Most of the intracranian Schwannomas are in the posterior fossa, developed from the VIIIth or Vth nerve stheath. The location on other cranian nerves is quite rare, only 6% of the orbital tumors being Schwannomas. We review the case of a 52 years old male patient, presenting for right eye exophthalmia and visual field deficit, diplopia due to VIth nerve paresis, and stubbing pain in the right eye, the MRI showing a tumor, located in the orbital apex displaced the globe forward and superiorly, and the optic nerve medially and superiorly. A modified lateral orbital approach was preferred. The choice of the orbitotomy allowed us to maintain the integrity of the lateral rim of the orbit without the need of a bony reconstruction at the end of the intervention, as it faced the anterior margin of the temporal muscle, covering it and not the skin over the zigomatic bone. The technical approach for orbital schwanomas should be tailored to reach the lesion through an esthetic incision and orbitotomy, immediately under the resected bone, with no need retracting the ocular globe or the vasculonervous elements in the orbit.


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