Thavara Binoy Damodar, Rajagopalawarrier Bijukrishnan, Balakrishnan Sunitha, Kidangan Geo Senil
Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India.
Department of Pathology, Government Medical College, Thrissur, Kerala, India.
Asian J Neurosurg. 2020 Feb 25;15(1):168-171. doi: 10.4103/ajns.AJNS_282_19. eCollection 2020 Jan-Mar.
Orbital lymphangioma is an intra-orbital, nonencapsulated, congenital vascular tumor with a propensity for recurrent hemorrhage. It is a common vascular tumor in children below 10 years of age. Adult orbital intraconal lymphangiomas are very rare. The authors present a case of 68-year-old male patient presented with left eye symptoms of decreased vision, proptosis, restricted eye movement, and diplopia. The symptoms started following a trauma to the left eye 6 months back. Contrast magnetic resonance imaging scan showed a contrast enhancing well-defined 2.2 cm × 1.8 cm × 1.8 cm fairly rounded, slightly lobulated intraconal tumor in the retrobulbar region inferior to optic nerve. Patient underwent the left fronto-temporo-orbito-zygomatic (FTOZ) craniotomy. The tumor was moderately vascular, firm in consistency with lobulated surface. Few foci of hemorrhages were seen. Near total excision of the tumor was done. Histopathology and immunohistochemistry confirmed the diagnosis of orbital lymphangioma. Although rare, intraconal orbital lymphangioma should be kept in the differential diagnosis of orbital tumors presenting in adult patients following a trauma. It can radiologically mimic other intraorbital tumors. It is a surgical challenge and FTOZ craniotomy provides direct access to the orbital intraconal compartment.
眼眶淋巴管瘤是一种眶内、无包膜的先天性血管肿瘤，易于反复出血。它是10岁以下儿童常见的血管肿瘤。成人眶内圆锥内淋巴管瘤非常罕见。作者报告一例68岁男性患者，出现左眼视力下降、眼球突出、眼球运动受限和复视症状。这些症状在6个月前左眼受外伤后开始出现。增强磁共振成像扫描显示，在视神经下方的球后区域有一个边界清晰、有强化的2.2厘米×1.8厘米×1.8厘米、相当圆润、略呈分叶状的圆锥内肿瘤。患者接受了左额颞眶颧（FTOZ）开颅手术。肿瘤血管中等丰富，质地硬，表面呈分叶状。可见少量出血灶。肿瘤几乎完全切除。组织病理学和免疫组织化学证实为眼眶淋巴管瘤。尽管罕见，但圆锥内眼眶淋巴管瘤应列入成年患者外伤后眼眶肿瘤的鉴别诊断中。它在影像学上可模仿其他眶内肿瘤。这是一个手术挑战，FTOZ开颅手术可直接进入眼眶圆锥内间隙。
