眶尖部海绵状血管瘤的影像特征和经颅手术

Imaging features and transcranial microsurgery of cavernous hemangioma of orbital apex

目的本文旨在探讨眶内海绵状血管瘤的影像特征和总结作者采用经颅入路切除眶尖部海绵状血管瘤的经验。方法对13年中经颅入路切除的16例眶尖部海绵状血管瘤进行回顾性分析。CT上肿瘤通常呈高密度,边界清楚,强化不明显。MRI上的特征性改变是因瘤内反复出血所致的不同时限血液成分的分房性。颈动脉造影无助于诊断。根据肿瘤大小和其所在眶内的间隙不同,选用单侧额部开颅或经额经眶上缘入路。结果16例均获全切除,无手术死亡。术后4例有暂时性动眼神经麻痹,1例并发硬膜外血肿,无其它手术并发症。13例获得随访,无复发。结论CT和MRI可使眶内海绵状血管瘤获得准确的定位和定性诊断。经颅入路手术是眶尖部海绵状血管瘤合适的选择。肿瘤通常可全切除,预后良好。

Objective The present article aims at exploring the imaging features of intraorbital cavernous hemangioma and introducing our experience treating intraorbital cavernous hemangioma that occupies the orbital apex using transcranial approaches. Method 16 patients with intraorbital cavernous hemangioma that occupy the orbital apex treated by transcranial approaches during recent 13 years were retropectively analysed.The tumor was a dense well-circumscribed mass on pre-enhanced CT.Contrast enhancement on CT was usually of mild degree,if present at all.MRI demonstrated a pathognomonic appearance of multiple compartments of blood of varying ages,ranging from the hyperintensity of methemoglobin to the hypointensity of hemosiderin.Carotid angiography was not helpful in diagnosis.We chose one of the two transcranial approaches to orbit, including ispilateral subfrontal approach and transorbitorimal- subfrontal approach, according to the size and location of the tumor. Result Total removal was achieved in all cases and there was no surgical death. Postoperatively,temporary oculomotor nerve palsy was resulted in 4 cases and epidural hematoma occurred in 1 case. There was no other surgical complication.In 13 cases followed up,there is no recurrent case. Conclusion Evaluation of the location and identification of intraorbital cavernous hemangioma is complete and specific with CT or MRI. We consider that transcranial approach is a suitable choice for intraorbital cavernous hemangioma that occupy the orbital apex .Usually the tumor can be totally removed and prognosis is good.