May Adrien T, Guatta Ramona, Meling Torstein R
Department of Neurosurgery, Geneva University Hospitals, Genéve, Switzerland.
Oper Neurosurg. 2021 Mar 15;20(4):E300. doi: 10.1093/ons/opaa389.
Cavernous hemangiomas of the orbit are low-pressure vascular tumors. Usually benign, they become symptomatic by the local mass effect, pushing the eyeball forward, causing exophthalmia, by oculomotor muscle and nerve compression causing diplopia or by optic nerve compression, leading to visual impairment. Radiotherapy is of limited value in their treatment because of the fragility of the optic nerve and subsequent blindness risk. Surgery remains the gold standard and definitive treatment. We illustrate in this video a transpalpebral superolateral orbitotomy and extirpation of an orbital cavernous hemangioma. A 52-yr-old healthy woman was sent for neurosurgical consultation by her ophthalmologist. She described a history of progressive unilateral right exophthalmia in the last months. A cerebral magnetic resonance imaging (MRI) revealed a 2.5-cm-large orbital lesion located superiorly and laterally to the eyeball. Surgery was proposed and accepted by the patient. The frontozygomatic component of the orbital rim needed to be removed to safely extirpate the cavernous hemangioma without exerting unnecessary and risky pressure on the eyeball.1,2 We decided to go for a superolateral orbitotomy via a transpalpebral incision.3 Total removal of the lesion was achieved with no complication. Exophthalmia normalized. Written patient consent was obtained for use and publication of their image after complete information. The patient consented to the surgery.
眼眶海绵状血管瘤是低压性血管肿瘤。通常为良性，它们因局部肿块效应而出现症状，将眼球向前推，导致眼球突出，因动眼肌和神经受压导致复视，或因视神经受压导致视力损害。由于视神经脆弱且有后续失明风险，放射治疗在其治疗中的价值有限。手术仍然是金标准和确定性治疗方法。我们在本视频中展示经睑上外侧眶切开术及眼眶海绵状血管瘤切除术。一名52岁健康女性由其眼科医生转来进行神经外科会诊。她描述在过去几个月中有进行性单侧右眼眼球突出病史。脑部磁共振成像（MRI）显示在眼球上方和外侧有一个2.5厘米大的眼眶病变。建议手术并被患者接受。需要切除眶缘的额颧部分，以安全切除海绵状血管瘤，而不对眼球施加不必要的风险压力。我们决定通过经睑切口进行上外侧眶切开术。病变被完全切除，无并发症。眼球突出恢复正常。在提供完整信息后，已获得患者书面同意使用和公布其图像。患者同意手术。
