Tanji Masahiro, Sano Noritaka, Hashimoto Jun, Kikuchi Masahiro, Matsunaga Mami, Kitada Yuji, Yamamoba Maki, Takeuchi Yasuhide, Makino Yasuhide, Hattori Etsuko Yamamoto, Terada Yukinori, Mineharu Yohei, Arakawa Yoshiki
Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Surg Neurol Int. 2025 Mar 21;16:98. doi: 10.25259/SNI_246_2024. eCollection 2025.
We present a case report describing the use of combined endoscopic endonasal and transorbital approach (EETOA) for intraorbital schwannoma that grew rapidly during pregnancy.
A 27-year-old woman who presented with headache was incidentally diagnosed with a tumor mass 1 cm in diameter near the right superior orbital fissure. Treatment of the tumor was deferred to follow-up. One month later, the patient became pregnant, and in the last trimester, she developed right abducens palsy and mildly dilated pupil. Magnetic resonance imaging (MRI) showed that the tumor mass had grown rapidly with a maximal diameter of 5 cm and had extended into the orbit through the superior orbital fissure. After spontaneous vaginal delivery, EETOA was planned to remove both the intraorbital region and cavernous sinus compartment to avoid craniotomy. Surgical resection began with an endoscopic endonasal approach. Orbital decompression was performed by removing the lamina papyracea, and the tumor was resected in the lateral cavernous sinus compartment. An eyebrow incision was made, and endoscopic transorbital surgery was performed to remove the intraorbital region. Multi-perspective views during EETOA enabled gross total resection of the tumor and confirmed by intraoperative MRI. The pathological diagnosis was schwannoma. The patient's abducens nerve palsy improved after surgery.
EETOA can offer maximal exposure and resection for tumors extending from the cavernous sinus to the orbit without craniotomy in selected cases.
我们报告一例病例，描述了采用内镜鼻内和经眶联合入路（EETOA）治疗妊娠期迅速生长的眶内神经鞘瘤。
一名27岁女性因头痛就诊，偶然被诊断出在右眶上裂附近有一个直径1厘米的肿瘤块。肿瘤治疗被推迟至随访。1个月后，患者怀孕，在孕晚期，她出现右侧展神经麻痹和瞳孔轻度散大。磁共振成像（MRI）显示肿瘤块迅速生长，最大直径达5厘米，并通过眶上裂延伸至眼眶。自然阴道分娩后，计划采用EETOA切除眶内区域和海绵窦区，以避免开颅手术。手术切除首先采用内镜鼻内入路。通过切除纸样板进行眼眶减压，并在海绵窦外侧区切除肿瘤。做眉部切口，进行内镜经眶手术以切除眶内区域。EETOA过程中的多视角观察实现了肿瘤的全切，并经术中MRI证实。病理诊断为神经鞘瘤。患者术后展神经麻痹有所改善。
在特定病例中，EETOA无需开颅即可为从海绵窦延伸至眼眶的肿瘤提供最大程度的暴露和切除。
