Yang Peng, Li Yong, Liu Hao-Cheng, Qiu E, Zhang Jia-Liang, Ren Jian, Jiang Li-Bin, Liu Hong-Gang, Kang Jun
Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2022 Feb 1;11:745479. doi: 10.3389/fonc.2021.745479. eCollection 2021.
The present study aims to analyse the clinical presentation, treatment and prognosis of a group of patients with orbital cavernous venous malformation (OCVM) with an insidious onset.
The clinical data of 35 patients with OCVM treated at our centre between 2003 and 2020 were retrospectively analysed. The OCVMs were classified as one of six types (I-VI) according to the orbital position of the tumour. The clinical characteristics, treatment methods and follow-up results were recorded.
A total of 35 patients with OCVM under the optic nerve sheath in the orbital apex area or the common tendon ring (Types I and II) were included in the present study. In 20 cases (57.1%), patients were misdiagnosed with optic neuritis, and in 20 cases (57.1%), the tumour was not identified based on imaging. The presentation was acute or subacute in 23 cases (65.7%). All patients underwent surgery: transnasal surgery in 22 cases (62.9%) and craniotomy in 13 cases (37.1%). A total of 9 patients (25.7%) experienced postoperative complications, and 17 patients (48.6%) experienced vision improvement. The average patient age at first diagnosis was 43.3 ± 10.3 years, and the median follow-up period was 64.5 months. Overall, 14 patients (40%) experienced postoperative complications: postoperative blindness in 6 cases, postoperative vision loss in 8 cases and orbital apex syndrome in 7 cases.
Patients with Type I and Type II OCVMs are the most complex cases. They have an insidious onset and are associated with a high rate of misdiagnosis and missed diagnosis. Acute and subacute decreases in visual acuity are mainly caused by OCVM haemorrhage. The difficulty of surgical treatment and the poor prognosis of postoperative vision are characteristics of this tumour. Transnasal surgery and craniotomy can be used to remove OCVMs located in the common tendon ring or optic canal as well as those involving the intracranial area through the supraorbital fissure. Meanwhile, the orbital approach (orbitotomy) has proven to be an effective method of treating OCVMs not involving the deep orbital apex and intracranial area.
本研究旨在分析一组隐匿性起病的眼眶海绵状静脉畸形（OCVM）患者的临床表现、治疗及预后。
回顾性分析2003年至2020年在本中心接受治疗的35例OCVM患者的临床资料。根据肿瘤在眼眶的位置，将OCVM分为六种类型（I - VI型）之一。记录临床特征、治疗方法及随访结果。
本研究共纳入35例眼眶尖区视神经鞘或总腱环下的OCVM患者（I型和II型）。20例（57.1%）患者被误诊为视神经炎，20例（57.1%）患者经影像学检查未发现肿瘤。23例（65.7%）患者表现为急性或亚急性。所有患者均接受了手术：经鼻手术22例（62.9%），开颅手术13例（37.1%）。共有9例（25.7%）患者出现术后并发症，17例（48.6%）患者视力改善。首次诊断时患者的平均年龄为43.3±10.3岁，中位随访期为64.5个月。总体而言，14例（40%）患者出现术后并发症：术后失明6例，术后视力下降8例，眼眶尖综合征7例。
I型和II型OCVM患者是最复杂的病例。它们起病隐匿，误诊和漏诊率高。视力急性和亚急性下降主要由OCVM出血引起。手术治疗困难及术后视力预后差是该肿瘤的特点。经鼻手术和开颅手术可用于切除位于总腱环或视神经管以及通过眶上裂累及颅内区域的OCVM。同时，眶入路（眶切开术）已被证明是治疗不涉及眼眶深部尖区和颅内区域的OCVM的有效方法。
