Akiyama Osamu, Tsutsumi Satoshi, Suga Yasuo, Abe Yusuke, Yasumoto Yukimasa, Ito Masanori
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Neurol Med Chir (Tokyo). 2009 May;49(5):209-12. doi: 10.2176/nmc.49.209.
A 25-year-old male presented with unilateral retroorbital dysesthesia persisting for 2 weeks followed by progressive palpebral ptosis without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection revealed mildly increased intraocular pressure and exophthalmos on the affected side, without conjunctival chemosis, restriction of the extraocular movements, double vision, or visual impairment. These symptoms did not vary with posture, straining, and Valsalva maneuver. Neuroimaging showed an irregularly-shaped orbital mass without enhancement mainly situated in the medial compartment of the orbit and encasing the optic nerve. Bruit was not audible and abnormal vasculatures were not identified in and around the affected orbit. Transcranial surgical exploration through the surgical window formed by the superior and medial rectus muscles revealed a purplish elastic-soft mass, heterogeneous in consistency and tightly adhering to the surrounding tissue, so cryoprobe-assisted radical tumor resection could not be completed without jeopardizing the optic nerve. The mass was subtotally resected piecemeal without postoperative visual impairment. The histological diagnosis was cavernous hemangioma. Orbital cavernous hemangiomas may present with an atypical appearance which confuses pretreatment diagnosis and makes surgical extirpation more hazardous. Conservative surgery should be indicated for poorly demarcated orbital cavernous hemangiomas considering the usual benign clinical course and postoperative sequelae.
一名25岁男性，出现单侧眶后感觉异常持续2周，随后渐进性上睑下垂，无前驱创伤、鼻窦手术或感染征象。神经眼科检查发现患侧眼压轻度升高及眼球突出，无结膜水肿、眼球运动受限、复视或视力损害。这些症状不随体位、用力和瓦尔萨尔瓦动作而改变。神经影像学显示一个不规则形状的眶内肿块，无强化，主要位于眶内侧间隙并包绕视神经。未闻及血管杂音，在患侧眼眶内及周围未发现异常血管。经由上直肌和内直肌形成的手术窗口进行经颅手术探查，发现一个紫色的弹性软肿块，质地不均，与周围组织紧密粘连，因此在不危及视神经的情况下无法完成冷冻探头辅助的肿瘤根治性切除。肿块被分块次全切除，术后无视力损害。组织学诊断为海绵状血管瘤。眼眶海绵状血管瘤可能表现为非典型外观，这会使术前诊断混淆，并使手术切除更具危险性。考虑到通常的良性临床过程和术后后遗症，对于边界不清的眼眶海绵状血管瘤应采取保守手术。
