From the Department of Otolaryngology-Head & Neck Surgery (A.J., A.E.L., B.S.B.)
Department of Otolaryngology-Head & Neck Surgery (A.J.), University of Washington, Seattle, Washington.
AJNR Am J Neuroradiol. 2020 Dec;41(12):2327-2332. doi: 10.3174/ajnr.A6822. Epub 2020 Oct 29.
Imaging is essential in the diagnostic work-up of patients with orbital lesions. The position of an orbital lesion relative to the inferomedial muscular trunk of the ophthalmic artery determines endoscopic resectability, anticipated technical difficulty, and patient morbidity. Although the inferomedial muscular trunk is not readily identifiable on preoperative imaging, we hypothesize that it is spatially approximate to the location where the ophthalmic artery crosses the optic nerve. Our aim was to determine whether the ophthalmic artery-optic nerve crosspoint anatomically approximates the inferomedial muscular trunk in a cadaver study and can be appreciated on imaging of known posteromedial orbital lesions.
Dissection was performed on 17 fresh-frozen cadaver orbits to assess the relationship between the inferomedial muscular trunk and ophthalmic artery-optic nerve crosspoint. Retrospective review of imaging in 9 patients with posteromedial orbital lesions assessed posteromedial orbital compartment characteristics and the ability to locate the ophthalmic artery-optic nerve crosspoint.
In our cadaver study, the mean distance between the ophthalmic artery-optic nerve crosspoint and the inferomedial muscular trunk was 1.21 ± 0.64 mm. Retrospectively, the ophthalmic artery-optic nerve crosspoint was identifiable in 9/9 patients, whereas the inferomedial muscular trunk was not identifiable in any patient. Total or partial effacement of the posteromedial intraconal fat triangle was observed in 9/9 patients.
This study of neurovascular relationships within the posteromedial orbit demonstrates that the ophthalmic artery-optic nerve crosspoint closely approximates the inferomedial muscular trunk and can be seen in patients with posteromedial orbital lesions. Posteromedial intraconal fat effacement may help to localize these lesions. These findings may facilitate multidisciplinary communication and help predict lesion resectability and patient outcomes.
影像学检查对于眼眶病变患者的诊断至关重要。眼眶病变相对于眼动脉内侧下肌干的位置决定了内镜切除的可行性、预期的技术难度和患者的发病率。尽管内侧下肌干在术前影像学检查中不易识别，但我们假设它与眼动脉穿过视神经的位置在空间上相近。我们的目的是在尸体研究中确定眼动脉-视神经交叉点在解剖上是否与内侧下肌干相近，并可在已知眶后内侧病变的影像学检查中观察到。
对 17 例新鲜冷冻尸体眼眶进行解剖，以评估内侧下肌干与眼动脉-视神经交叉点之间的关系。回顾性分析 9 例眶后内侧病变患者的影像学资料，评估眶后内侧间隙的特征及定位眼动脉-视神经交叉点的能力。
在我们的尸体研究中，眼动脉-视神经交叉点与内侧下肌干之间的平均距离为 1.21±0.64mm。回顾性分析中，9 例患者均能识别眼动脉-视神经交叉点，而无一例患者能识别内侧下肌干。9 例患者均观察到眶后内侧间隙内的脂肪三角完全或部分消失。
本研究对眶后内侧的神经血管关系进行了研究，结果表明眼动脉-视神经交叉点与内侧下肌干位置相近，可在眶后内侧病变患者中观察到。眶后内侧间隙内的脂肪消失可能有助于定位这些病变。这些发现可能有助于多学科之间的沟通，并有助于预测病变的可切除性和患者的预后。
