Imaging characteristics and surgical management of orbital neurilemmomas
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摘要
AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography(CT) and magnetic resonance imaging(MRI).RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75 y(average, 40.3 y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1 WI revealed isointense or hypointense tumors, while the T2 WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean followup of 1.8 y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas.Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.
AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography(CT) and magnetic resonance imaging(MRI).RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75 y(average, 40.3 y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1 WI revealed isointense or hypointense tumors, while the T2 WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean followup of 1.8 y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas.Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.
AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography(CT) and magnetic resonance imaging(MRI).RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75 y(average, 40.3 y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1 WI revealed isointense or hypointense tumors, while the T2 WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean followup of 1.8 y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas.Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.
引文
1 Shields JA,Shields CL.Orbital schwannoma.In:Shields JA,Shields CL,eds.Eyelid,Conjunctival and Orbital Tumors.An Atlas and Textbook.3rd ed.Philadelphia,PA:Wolters Kluwer;2016:552-555.
2 Shields JA,Shields CL,Scartozzi R.Survey of 1264 patients with orbital tumors and simulating lesions:The 2002 Montgomery Lecture,part 1.Ophthalmology 2004;111(5):997-1008.
3 Konrad EA,Thiel HJ.Schwannoma of the orbit.Ophthalmologica1984;188(2):118-127.
4 Pushker N,Khurana S,Kashyap S,Sen S,Shrey D,Meel R,Chawla B,Bajaj MS.Orbital schwannoma:a clinicopathologic study.Int Ophthalmol2015;35(4):481-486.
5 Pointdujour-Lim R,Lally SE,Shields JA,Eagle RC Jr,Shields CL.Orbital schwannoma:radiographic and histopathologic correlation in 15cases.Ophthalmic Plast Reconstr Surg 2018;34(2):162-167.
6 Young SM,Kim YD,Jeon GS,Woo KI.Orbital frontal nerve schwannomadistinctive radiological features.Am J Ophthalmol 2018;186:41-46.
7 Wang Y,Xiao LH.Orbital schwannomas:findings from magnetic resonance imaging in 62 cases.Eye(Lond)2008;22(8):1034-1039.
8 Kim KS,Jung JW,Yoon KC,Kwon YJ,Hwang JH,Lee SY.Schwannoma of the orbit.Arch Craniofac Surg 2015;16(2):67-72.
9 Kron M,Bohnsack BL,Archer SM,McHugh JB,Kahana A.Recurrent orbital schwannomas:clinical course and histopathologic correlation.BMC Ophthalmol 2012;12:44.
10 Koktekir BE,Kim HJ,Geske M,Bloomer M,Vagefi R,Kersten RC.Orbital schwannomatosis in the absence of neurofibromatosis.J Craniofac Surg 2014;25(6):2109-2111.
11 Kashyap S,Pushker N,Meel R,Sen S,Bajaj MS,Khuriajam N,Mehta M,Chawla B.Orbital schwannoma with cystic degeneration.Clin Exp Ophthalmol 2009;37(3):293-298.
12 Skolnik AD,Loevner LA,Sampathu DM,Newman JG,Lee JY,Bagley LJ,Learned KO.Cranial nerve schwannomas:diagnostic imaging approach.Radiographics 2016;36(5):1463-1477.
13 Yulek F,Demer JL.Isolated schwannoma involving extraocular muscles.J AAPOS 2016;20(4):343-347.
14 Yan J,Wu Z.Cavernous hemangioma of the orbit:analysis of 214cases.Orbit 2004;23(1):33-40.
15 Paulsen F,Doerr S,Wilhelm H,Becker G,Bamberg M,Classen J.Fractionated stereotactic radiotherapy in patients with optic nerve sheath meningioma.Int J Radiat Oncol Biol Phys 2012;82(2):773-778.
16 Yang M,Yan J.Long term surgical outcomes of orbital cavernous haemangiomas(low-flow venous malformations)as performed in a tertiary eye hospital in China.J Craniomaxillofac Surg 2014;42(7):1491-1496.
17 Dutton JJ.Optic nerve sheath meningiomas.Surv Ophthalmol1992;37(3):167-183.
18 Ghassibi MP,Ulloa-Padilla JP,Dubovy SR.Neural tumors of the orbit:what is new?Asia Pac J Ophthalmol(Phila)2017;6(3):273-282.
19 Li J,Lin J,Liu R,Li J,Yan J.Orbital schwannoma originating from the superior oblique muscle.J Craniofac Surg 2015;26(2):559-560.
20 Schick U,Bleyen J,Hassler W.Treatment of orbital schwannomas and neurofibromas.Br J Neurosurg 2003;17(6):541-545.
21 Irace C,DavìG,Corona C,Candino M,Usai S,Gambacorta M.Isolated intraorbital schwannoma arising from the abducens nerve.Acta Neurochir(Wien)2008;150(11):1209-1210.
22 Rato RM,Correia M,Cunha JP,Roque PS.Intraorbital abducens nerve schwannoma.World Neurosurg 2012;78(3-4):375.e1-375.e4.
23 Champagne PO,Desrosiers M,Moumdjian R.Endoscopic resection of an infraorbital nerve schwannoma.Clin Neurol Neurosurg 2014;119:106-109.
24 Butt ZA,McNab AA.Orbital neurilemmoma:report of seven cases.JClin Neurosci 1998;5(4):390-393.
25 Subramanian N,Rambhatia S,Mahesh L,Menon SV,Krishnakumar S,Biswas J,Noronha OV.Cystic schwannoma of the orbit-a case series.Orbit 2005;24(2):125-129.
26 Sun H,Sharma K,Kalakoti P,Thakur JD,Patra DP,Konar S,Maiti T,Akbarian-Tefaghi H,Bollam P,Notarianni C,Nanda A.Factors associated with abducens nerve recovery in patients undergoing surgical resection of sixth nerve schwannoma:a systematic review and case illustration.World Neurosurg 2017;104:883-899.
27 Rootman J,Goldberg C,Robertson W.Primary orbital schwannomas.Br J Ophthalmol 1982;66(3):194-204.
2 Shields JA,Shields CL,Scartozzi R.Survey of 1264 patients with orbital tumors and simulating lesions:The 2002 Montgomery Lecture,part 1.Ophthalmology 2004;111(5):997-1008.
3 Konrad EA,Thiel HJ.Schwannoma of the orbit.Ophthalmologica1984;188(2):118-127.
4 Pushker N,Khurana S,Kashyap S,Sen S,Shrey D,Meel R,Chawla B,Bajaj MS.Orbital schwannoma:a clinicopathologic study.Int Ophthalmol2015;35(4):481-486.
5 Pointdujour-Lim R,Lally SE,Shields JA,Eagle RC Jr,Shields CL.Orbital schwannoma:radiographic and histopathologic correlation in 15cases.Ophthalmic Plast Reconstr Surg 2018;34(2):162-167.
6 Young SM,Kim YD,Jeon GS,Woo KI.Orbital frontal nerve schwannomadistinctive radiological features.Am J Ophthalmol 2018;186:41-46.
7 Wang Y,Xiao LH.Orbital schwannomas:findings from magnetic resonance imaging in 62 cases.Eye(Lond)2008;22(8):1034-1039.
8 Kim KS,Jung JW,Yoon KC,Kwon YJ,Hwang JH,Lee SY.Schwannoma of the orbit.Arch Craniofac Surg 2015;16(2):67-72.
9 Kron M,Bohnsack BL,Archer SM,McHugh JB,Kahana A.Recurrent orbital schwannomas:clinical course and histopathologic correlation.BMC Ophthalmol 2012;12:44.
10 Koktekir BE,Kim HJ,Geske M,Bloomer M,Vagefi R,Kersten RC.Orbital schwannomatosis in the absence of neurofibromatosis.J Craniofac Surg 2014;25(6):2109-2111.
11 Kashyap S,Pushker N,Meel R,Sen S,Bajaj MS,Khuriajam N,Mehta M,Chawla B.Orbital schwannoma with cystic degeneration.Clin Exp Ophthalmol 2009;37(3):293-298.
12 Skolnik AD,Loevner LA,Sampathu DM,Newman JG,Lee JY,Bagley LJ,Learned KO.Cranial nerve schwannomas:diagnostic imaging approach.Radiographics 2016;36(5):1463-1477.
13 Yulek F,Demer JL.Isolated schwannoma involving extraocular muscles.J AAPOS 2016;20(4):343-347.
14 Yan J,Wu Z.Cavernous hemangioma of the orbit:analysis of 214cases.Orbit 2004;23(1):33-40.
15 Paulsen F,Doerr S,Wilhelm H,Becker G,Bamberg M,Classen J.Fractionated stereotactic radiotherapy in patients with optic nerve sheath meningioma.Int J Radiat Oncol Biol Phys 2012;82(2):773-778.
16 Yang M,Yan J.Long term surgical outcomes of orbital cavernous haemangiomas(low-flow venous malformations)as performed in a tertiary eye hospital in China.J Craniomaxillofac Surg 2014;42(7):1491-1496.
17 Dutton JJ.Optic nerve sheath meningiomas.Surv Ophthalmol1992;37(3):167-183.
18 Ghassibi MP,Ulloa-Padilla JP,Dubovy SR.Neural tumors of the orbit:what is new?Asia Pac J Ophthalmol(Phila)2017;6(3):273-282.
19 Li J,Lin J,Liu R,Li J,Yan J.Orbital schwannoma originating from the superior oblique muscle.J Craniofac Surg 2015;26(2):559-560.
20 Schick U,Bleyen J,Hassler W.Treatment of orbital schwannomas and neurofibromas.Br J Neurosurg 2003;17(6):541-545.
21 Irace C,DavìG,Corona C,Candino M,Usai S,Gambacorta M.Isolated intraorbital schwannoma arising from the abducens nerve.Acta Neurochir(Wien)2008;150(11):1209-1210.
22 Rato RM,Correia M,Cunha JP,Roque PS.Intraorbital abducens nerve schwannoma.World Neurosurg 2012;78(3-4):375.e1-375.e4.
23 Champagne PO,Desrosiers M,Moumdjian R.Endoscopic resection of an infraorbital nerve schwannoma.Clin Neurol Neurosurg 2014;119:106-109.
24 Butt ZA,McNab AA.Orbital neurilemmoma:report of seven cases.JClin Neurosci 1998;5(4):390-393.
25 Subramanian N,Rambhatia S,Mahesh L,Menon SV,Krishnakumar S,Biswas J,Noronha OV.Cystic schwannoma of the orbit-a case series.Orbit 2005;24(2):125-129.
26 Sun H,Sharma K,Kalakoti P,Thakur JD,Patra DP,Konar S,Maiti T,Akbarian-Tefaghi H,Bollam P,Notarianni C,Nanda A.Factors associated with abducens nerve recovery in patients undergoing surgical resection of sixth nerve schwannoma:a systematic review and case illustration.World Neurosurg 2017;104:883-899.
27 Rootman J,Goldberg C,Robertson W.Primary orbital schwannomas.Br J Ophthalmol 1982;66(3):194-204.