Centro Especializado en Neurocirugía y Neurociencias Mexico (CENNM), Mexico City, Mexico.
Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, Mexico.
J Med Case Rep. 2021 Jan 22;15(1):18. doi: 10.1186/s13256-020-02579-3.
Cholesteatomas are benign tumors mainly composed of cholesterol crystals that rarely arise within the orbit. However, orbital cholesteatomas require a complete surgical resection due to their recidivating potential. Transcranial approaches offering a broad surgical exposure of the orbital cavity have been scarcely used for the management of these tumors. Here, we provide evidence of the benefits of the pterional craniotomy for the surgical resection of orbital tumors by sharing our experience in the surgical management of a cholesteatoma of the superotemporal orbital wall.
A 45-year-old Hispanic man with a 2-year history of progressive proptosis of the left eye attended to our center complaining of diplopia and migraine. At his arrival, physical examination revealed ptosis, palpebral edema, and exophthalmos of the left eye, as well as the abolishment of the ipsilateral photomotor and consensual responses. Fundoscopy showed mild optic atrophy, whereas a T2-weighted magnetic resonance imaging (MRI) of the head showed a hyperintense mass arising at the superotemporal wall of the orbit that was displacing the eyeball. The tumor was resected using a pterional craniotomy without postoperative complications. The histopathological analysis of the tumor revealed a cholesteatoma. The patient recovered the functionality of the left eye with no visual sensitive deficits nor tumor recurrence 1 year after the surgery.
Our results support the use of the pterional craniotomy as a safe procedure for the surgical resection of cholesteatomas arising at the superotemporal walls of the orbit, with low postoperative morbidity.
胆脂瘤是一种良性肿瘤，主要由胆固醇晶体组成，很少发生在眼眶内。然而，由于其具有复发性，因此需要进行彻底的手术切除。颅眶沟通入路提供了广泛的眶腔手术暴露，很少用于这些肿瘤的治疗。在这里，我们通过分享我们在眼眶顶壁胆脂瘤手术治疗中的经验，为经翼点入路切除眼眶肿瘤提供了证据。
一名 45 岁的西班牙裔男性，左眼进行性眼球突出 2 年，就诊于我院，主诉复视和偏头痛。就诊时，体格检查发现左眼上睑下垂、眼睑水肿和眼球突出，同侧光动和对光反射消失。眼底检查显示轻度视神经萎缩，头部 T2 加权磁共振成像（MRI）显示眼眶顶壁有一个高信号的肿块，眼球被推挤移位。肿瘤通过翼点开颅术切除，术后无并发症。肿瘤的组织病理学分析显示为胆脂瘤。患者术后 1 年左眼功能恢复，无视觉敏感缺陷，也无肿瘤复发。
我们的结果支持经翼点入路作为一种安全的手术方法，用于切除发生在眼眶顶壁的胆脂瘤，术后发病率低。
