Transconjunctival Extirpation of a Voluminous Orbital Cavernoma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Adrien T May ◽  
Ramona Guatta ◽  
Torstein R Meling
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Surgical Resection ◽  
Gold Standard ◽  
Rectus Muscle ◽  
Medial Rectus ◽  
Orbital Tumors ◽  
Definitive Solution ◽  
Retrobulbar Space

Abstract Purely intraorbital cavernomas remain rare, but still are the most common benign orbital tumors.1 These expansive lesions are now rapidly detected and adequately treated. Surgical resection is the gold standard and a definitive solution. The choice of approach varies between different possibilities, including orbitotomies, trans-sinusal routes, and transconjunctival accesses.2-4 Because the last technique is less known to the neurosurgeon, we describe here a step-by-step guide to perform it.  The technique is illustrated with the case of a 62-yr-old male with a voluminous right retroocular cavernoma. He presented a progressive right exophthalmia without visual acuity or campimetric deterioration. Because the cavernoma was purely medial from the optic nerve in the intraconal space, no osteotomy was deemed necessary to extirpate the lesion. The video shows the conjunctival dissection, followed by the medial rectus muscle being dissected, allowing us to attain the retrobulbar space in the orbit. The cavernoma is then dissected from the surroundings and reduced in volume by coagulation so its removal does not apply hyperpressure on the adjacent fragile structures. We then pursue with the closure by stitching the medial rectus muscle to the eyeball. Finally, the conjunctiva is sutured.  Postoperatively, there was no complication. A transient mydriasis due to ciliary nerve manipulation spontaneously resolved. Extirpation of the lesion was total. The patient's exophthalmia normalized over the next months. No visual or campimetric deterioration was noted at follow-up. A slight horizontal diplopia was noted after surgery, which normalized at 1 yr. The patient's consent was obtained for the procedure.

scholarly journals Multisession Gamma Knife surgery for benign orbital tumors

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 102-107 ◽  
Author(s):  
Kyung-Il Jo ◽  
Yong Seok Im ◽  
Doo-Sik Kong ◽  
Ho Jun Seol ◽  
Do-Hyun Nam ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Gamma Knife ◽  
Direct Contact ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Orbital Tumors ◽  
Cavernous Hemangiomas

Object The goal of this study was to investigate the safety and efficacy of multisession Gamma Knife surgery (GKS) in the treatment of benign orbital tumors. Methods Twenty-three patients who retained their vision despite having tumors touching their optic nerve were treated with multisession (4-fraction) GKS. The median tumor volume was 2800 mm3 (range 211–10,800 mm3), and the median cumulative margin dose was 20 Gy (range 18–22 Gy). Results The median clinical follow-up duration in these patients was 38 months (range 9–74 months). No patient experienced tumor progression in this study. In particular, a higher degree of tumor shrinkage was found in the 7 patients with cavernous hemangiomas than in patients with other types of lesions (p < 0.05). Of the 23 patients whose preoperative vision was preserved, 11 showed improvement in visual acuity and/or visual field and 12 showed stable visual acuity. No GKS-related adverse events were noted during or after treatment. Conclusions Multisession radiosurgery using the Gamma Knife may be a good strategy for tumors in direct contact with the optic nerve. A cumulative margin dose of up to 22 Gy delivered in 4 sessions is safe for preservation of visual function with a high probability of tumor control.

Gamma Knife surgery in the management of orbital tumors

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 34-38 ◽  
Author(s):  
Desheng Xu ◽  
Dong Liu ◽  
Zhiyuan Zhang ◽  
Yipei Zhang ◽  
Yanhe Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Gamma Knife ◽  
Target Volume ◽  
Gamma Knife Surgery ◽  
Orbital Tumors ◽  
Acute Side Effect ◽  
Choroidal Melanomas ◽  
Excellent Preservation ◽  
Severe Deterioration

Object The authors evaluated the results they obtained using Gamma Knife surgery (GKS) in patients with orbital tumors. Methods This is a retrospective clinical evaluation of 202 patients with orbital tumors who were treated with GKS between September 1995 and October 2008. The series included 84 men and 118 women with a mean age of 39.5 ± 14.6 years (range 5–85 years). The diagnoses were determined based on pathological analyses in 113 patients and presumed based on characteristic clinical and imaging findings in 89 patients. There were 84 meningiomas, 38 epithelial tumors of the lacrimal gland, 23 schwannomas, 18 malignant choroidal melanomas, 12 optic nerve gliomas, 11 orbital metastases, 10 pseudotumors of the orbit, 3 retinoblastomas, and 3 cases of fibromatosis. The median target volume was 5.4 cm3 (range 0.04–35.6 cm3). The tumor margin dose ranged from 10 to 40 Gy. Results At a median follow-up period of 34.5 ± 14.7 months (range 12–114 months), tumor shrinkage was observed in 118 patients (58.4%) and stable tumor size in 71 patients (35.1%). Regularly scheduled neuroimaging studies demonstrated evidence of tumor progression in only 13 patients (6.4%): 9 of these patients underwent repeated GKS and 4 received surgical treatment. Visual acuity was preserved in 129 patients. Seventy-two patients experienced some degree of improvement in vision. Severe deterioration of visual acuity was found in 18 of 147 patients who had useful vision before treatment. Nineteen patients (9.4%) experienced transient conjunctival edema; no other serious acute side effect was observed. Conclusions Gamma Knife surgery provides an effective management strategy in patients with orbital tumors; it achieves excellent preservation of neurological function and is associated with few treatment-related complications.

Adult nasal glioma presenting with visual loss

2010 ◽  
Vol 124 (12) ◽  
pp. 1309-1313 ◽  
Author(s):  
A Majithia ◽  
S H Liyanage ◽  
R Hewitt ◽  
W E Grant
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Loss ◽  
English Language ◽  
Incidental Finding ◽  
Relevant Literature ◽  
Nasal Glioma ◽  
Cranial Fossa ◽  
Skull Base Defect

AbstractObjectives:We report a rare case of a nasal glioma found incidentally in an adult, presenting with visual loss, optic nerve oedema and proptosis.Case report:A 41-year-old woman presented with bilateral proptosis, impairment in visual acuity (6/60 bilaterally) and loss of colour vision. Computed tomography and magnetic resonance imaging showed proptosis, bilateral optic nerve swelling and a heterogeneous mass occupying the left nasal cavity and extending through a skull base defect into the anterior cranial fossa. Biopsy confirmed a nasal glioma. Treatment with intravenous dexamethasone resolved the proptosis, and the patient's visual acuity recovered to 6/9 bilaterally. At the multidisciplinary team meeting, it was felt that the nasal glioma probably represented an incidental finding and was not directly responsible for the patient's proptosis and transient visual loss.Conclusion:To our knowledge, this is the first report in the English language literature of adult nasal glioma presenting with visual loss. The management of nasal gliomas in adults is contentious and the relevant literature is reviewed. This case was managed conservatively with regular follow up.

Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma

2018 ◽  
Vol 103 (10) ◽  
pp. 1436-1440 ◽  
Author(s):  
Ravi Pandit ◽  
Liliana Paris ◽  
Danielle S Rudich ◽  
Robert L Lesser ◽  
Mark J Kupersmith ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Symptom Onset ◽  
Conformal Radiotherapy ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
The Mean

Background/AimFractionated conformal radiotherapy (FCRT) is now used to treat vision-threatening optic nerve sheath meningioma (ONSM), but long-term efficacy and safety data are lacking; the purpose of this study was to assess these key data.MethodsThis is a retrospective chart review with prospective follow-up of adult patients treated with FCRT for primary ONSM at four academic medical centres between 1995 and 2007 with ≥10 years of follow-up after treatment.Results16 patients were identified with a mean post-treatment follow-up of 14.6 years (range: 10.5–20.7 years). The mean age at symptom onset was 47.6 years (range: 36–60 years). FCRT was performed at a mean of 2.3 years after symptom onset (range: 0.2–14.0 years). At last follow-up, visual acuity had improved or stabilised in 14 of the 16 (88%) patients, and 11 (69%) had retained or achieved ≥20/40. The mean deviation on automated perimetry remained stable (−14.5 dB pretreatment vs −12.2 dB at last follow-up; p=0.68, n=10). Two (11%) patients had persistent pain, proptosis or diplopia, compared with six (38%) pretreatment (p=0.11). Two (13%) patients developed radiation retinopathy more than 6 months after completion of therapy, one (50%) of whom had worse visual acuity compared with pretreatment. No patient developed tumour involvement or radiation damage in the fellow eye.ConclusionFCRT stabilises or improves visual function in patients with primary ONSM and is associated with a low risk of significant ocular sequelae. This treatment should be considered instead of surgery in patients with primary ONSM who require intervention due to loss of visual sensory and/or ocular motor function.

scholarly journals Navigation-assisted endonasal endoscopic optic nerve decompression in fibrous dysplasia

2019 ◽  
Vol 12 (12) ◽  
pp. e230621 ◽  
Author(s):  
Ramya Thota ◽  
Rakesh Kumar ◽  
Rajeev Kumar ◽  
Bhinyaram Jat
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Fibrous Dysplasia ◽  
Nerve Decompression ◽  
Post Surgery ◽  
Corrected Visual Acuity ◽  
Optic Nerve Decompression ◽  
Stable Vision ◽  
Best Corrected Visual Acuity

A 12-year-old girl presented with left-sided decreased vision of 2-month duration. Clinical evaluation and imaging revealed fibrous dysplasia compressing the left optic nerve with no underlying endocrinological abnormalities. Best-corrected visual acuity showed progressive deterioration of vision over 2-month follow-up. She underwent navigation-assisted endonasal endoscopic optic nerve decompression. Post-surgery there was improvement in vision and it became normal (6/6). Six-month follow-up showed stable vision with no further complications.

scholarly journals Ocular imaging findings of bilateral optic disc pit in a child

2013 ◽  
Vol 5 (2) ◽  
pp. 258-261 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Z Alkin ◽  
AT Taylan ◽  
A Demirok
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Anterior Segment ◽  
Rare Condition ◽  
Optic Disc Pit ◽  
Fiber Layer ◽  
Retinal Nerve Fiber

Background: To report a rare condition of bilateral optic disc pit in a child. Case description: A ten-year-old female was admitted with a complaint of headache. Visual acuity was 20/20 in both eyes (OU). Anterior segment examination was normal in OU. Fundus examination revealed optic disc pit (ODP) located temporally with a diameter of 1/5 disc diameter in OU. Intraocular pressure was within normal limits in both eyes. Macular optical coherence tomography (OCT) showed a loss of retinal tissue at the site corresponding to the ODP in both eyes. Retinal nerve fiber OCT revealed decreased RNFL thickness at the temporal side of the optic nerve, corresponding to the ODP in both eyes. The patient and patient’s parents were informed about the disease and called for follow-up examinations every 6 months. In addition, the family was informed about optic pit maculopathy (OPM) and, they were told to return immediately if the patient ever complained of decreased vision in either of her eyes. After a follow-up period of 12 months, visual acuity remained stable, and no complications secondary to ODP were detected. Conclusion: Optic disc pit is diagnosed incidentally unless it is complicated with OPM. The retinal nerve fiber layer thickness is decreased at the side of the optic nerve corresponding to the ODP. Nepal J Ophthalmol 2013; 5(10): 258-261 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8739

Modified Y- split and recession of medial rectus muscles in convergence excess esotropia

2020 ◽  
pp. 112067212096549
Author(s):  
Abbas Bagheri ◽  
Ehsan Abbasnia ◽  
Mehdi Tavakoli
Keyword(s):  
Rectus Muscle ◽  
Medial Rectus ◽  
Final Visit ◽  
Modified Technique ◽  
Long Term Follow Up ◽  
The Mean ◽  
Residual Distance ◽  
Convergence Excess

Purpose: The convergence excess esotropia (CEET) is defined when near esotropia is greater than the distance by at least 10 PD while the eye is corrected with the full cycloplegic refraction. The purpose of this study is to evaluate the effect of a modified technique of Y- split recession of the medial rectus muscles on CEET. Methods: This was a retrospective study on patients diagnosed with CEET. The surgery included longitudinally dividing the medial rectus muscles into two equal halves and re-attaching them in a recessed and one-tendon width apart position. Success was defined as a residual distance and near esotropia of less than 10 PD and a distance-near disparity of less than 5 PD. Results: Fourteen patients, including 8 (57.1%) females, were enrolled with a mean age of 7.1 ± 2.9 years. The mean follow-up period was 28.6 ± 12.1 months. The mean preoperative distance and near esotropia was 31 ± 10 and 45 ± 11.3 PD respectively that decreased to 2.4 ± 3 and 3.6 ± 3.8 PD at the final visit ( p < 0.001). The Mean distance-near disparity of esotropia was 14 ± 4.5 PD before the operation that decreased to 1.3 ± 1.8 PD at the final visit ( p < 0.001). The motor success rate was 78.6%, bifocal glasses were no more required in 92.9% of patients, and stereopsis improved in 35.7% of patients after the surgery. Conclusion: Bilateral modified Y- split and recession of the medial rectus muscle is an effective technique for the treatment of CEET with persistent outcomes in the long-term follow-up.

scholarly journals Y-Split Recession of the Medial Rectus Muscle as a Secondary and/or Unilateral Procedure in the Treatment of Esotropia with Distance/Near Disparity

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Monika Wipf ◽  
Siegfried Priglinger ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Side Effects ◽  
Treatment Option ◽  
Rectus Muscle ◽  
Medial Rectus ◽  
Long Term Results ◽  
Posterior Fixation ◽  
Secondary Surgery ◽  
Lateral Rectus Muscle

Introduction. In esotropia with larger angles > near than at distance, splitting of the medial rectus muscle has been suggested as a treatment option. Previous reports of bilateral medial rectus Y-splitting as a first intervention showed a reduction of the distance/near disparity with fewer side effects compared to posterior fixation surgery. We address whether a medial rectus Y-splitting as a secondary and/or a unilateral procedure also reduce distance/near disparity.Materials and Methods. We retrospectively reviewed the charts of four patients undergoing Y-split recession as a second and/or unilateral surgery. Main outcomes were distance/near disparity and squint angles.Results and Discussion.Three of the four patients had undergone unilateral Y-splitting of the medial rectus as a secondary surgery, three as a unilateral procedure. Mean distance/near disparity was reduced from 17 PD preoperatively to zero at the final follow-up (FU). Preoperative angles ranged from 45 PD to 66 PD at near and from 25 PD to 55 PD at distance. At the final FU, these angles ranged from 0 PD to 20 PD at near and at distance. Mean FU was 42 months (range: 12–60 months).Conclusion. Y-split recession as a secondary and/or unilateral surgery for distance/near esotropia can reduce distance/near disparity with good long-term results. Residual esotropia can be corrected by adding resection of the lateral rectus muscle.

scholarly journals Management of Systemic Steroid in HIV Patient with Toxoplasma Papillitis

2019 ◽  
Vol 7 (11) ◽  
pp. 1821-1824
Author(s):  
AA Mas Putrawati Triningrat ◽  
Ratna Sari Dewi ◽  
Igam Juliari ◽  
NK Niti Susila ◽  
Ni Made Ayu Surasmiati ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Nerve Head ◽  
Systemic Steroid ◽  
Laboratory Examination ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
The Right

BACKGROUND: Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii. Ocular manifestations are seen in both congenital and acquired toxoplasmosis. These can include focal inflammation within or around the optic nerve head (papillitis). Purpose of this study is evaluating the efficacy of systemic steroid in HIV patient with toxoplasma papillitis. CASE PRESENTATION: We present a case report of a male, 46 years old with a decrease of visual acuity on the right eye for three weeks before admission to the hospital. An ophthalmology examination showed visual acuity of the right eye 1/60, mild dilatation of the pupil and posterior synechiae, vitreous was hazy, and fundus examination showed optic nerve head not well demarcated and hyperaemic with the good retina and macula reflex. Laboratory examination showed reactive anti-Toxoplasma immunoglobulin G. Patient had been treated with antiretroviral and anti-Toxoplasma drugs, then he was given steroid 250 mg intravenously four times per day for three days and tapering off orally. Visual acuity on the right eye improve from 1/60 became 6/60 after use of steroid on the third day. DISCUSSION: Steroid can improve visual acuity for toxoplasma papillitis in this patient. But the long term and close follow up in steroid therapy is needed.

Outcomes of bilateral lateral rectus recession in treatment of recurrent exotropia after bilateral medial rectus resection

2018 ◽  
Vol 29 (4) ◽  
pp. 402-405
Author(s):  
Amr Elkamshoushy ◽  
Michael A Langue
Keyword(s):  
Chart Review ◽  
Rectus Muscle ◽  
Retrospective Chart Review ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Primary Surgery ◽  
Lateral Rectus Muscle ◽  
Recurrent Exotropia ◽  
Large Primary

Purpose: To report the results of bilateral lateral rectus muscle recession for recurrent exotropia in cases where the primary surgery was a bilateral medial rectus resection. Methods: Retrospective chart review of 15 subjects who completed 6 months of follow-up. Data collected included patients’ demographics and pre- and post-operative measurements of ocular alignment and motility. Surgical nomogram used was the same nomogram we use for primary cases of exotropia. Results: At 6-month follow-up, 73.3% of cases had a successful surgical outcome (defined as 8 PD of esotropia to 10 PD of exotropia). In addition, recession of lateral rectus muscles against the previously resected medial recti did not result in a significant increase in the limitation of abduction. Conclusion: Bilateral lateral rectus recession using standard surgical tables is a safe and effective method for treating recurrent exotropia following bilateral medial rectus resection. Even large primary resections up to 12 mm do not seem to affect the results of bilateral lateral rectus recession.

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