Combination treatment of a rare case of a cavernous hemangioma of the orbit

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Abstract

A case of atypical course of cavernous hemangioma of the orbit. A necessity of a multidisciplinary approach to the diagnosis and surgical treatment of an orbital neoplasm is shown.

About the authors

Dmitriy S. Gorbachev

S.M. Kirov Military Medical Academy

Email: dmitrij-gor@yandex.ru

Candidate of Medical Sciences, Associate Professor, Assistant, Ophthalmology Department

Russian Federation, Saint Petersburg

Alexey N. Kulikov

S.M. Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
SPIN-code: 6440-7706
Scopus Author ID: 198153

MD, PhD, DMedSc, Professor, Head of the Department, Ophthalmology Department

Russian Federation, Saint Petersburg

Dmitriy V. Svistov

S.M. Kirov Military Medical Academy

Email: kolba81@yandex.ru
ORCID iD: 0000-0002-3922-9887

Candidate of Medical Sciences, Head of the Department, Department of Neurosurgery

Russian Federation, Saint Petersburg

Alexander V. Savello

S.M. Kirov Military Medical Academy

Email: kolba81@yandex.ru
SPIN-code: 3185-9332
Scopus Author ID: 694310

Doctor of Medical Science, Associate Professor, Deputy Head of the Department of Neurosurgery

Russian Federation, Saint Petersburg

Aleksej A. Kol’bin

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: kolba81@yandex.ru
SPIN-code: 4718-5171

Neurosurgeon, Department of Clinic, Neurosurgery Department

Russian Federation, Saint Petersburg

Roman S. Martynov

S.M. Kirov Military Medical Academy

Email: kolba81@yandex.ru
ORCID iD: 0000-0002-2769-3551
SPIN-code: 1175-2029
Scopus Author ID: 915454

Neurosurgeon, Department of Clinic, Neurosurgery Department

Russian Federation, Saint Petersburg

Tat’jana A. Leongardt

S.M. Kirov Military Medical Academy

Email: leongardtta@yandex.ru
SPIN-code: 3818-4965
Scopus Author ID: 883954

Candidate of Medical Sciences, Lecturer of the Ophthalmology Department

Russian Federation, Saint Petersburg

References

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  2. Бровкина А.Ф. Новообразования орбиты. – М.: Медицина, 1974. [Brovkina AF. Novoobrazovaniya orbity. Moscow: Meditsina; 1974. (In Russ.)]
  3. Опухоли глаза, его придатков и орбиты / под ред. Н.А. Пучковской. – Киев: Здоров’я, 1978. [Opukholi glaza, ego pridatkov i orbity. Ed. by N.A. Puchkovskaya. Kiev: Zdorov’ya; 1978. (In Russ.)]
  4. Wang X, Yan J. Multiple cavernous hemangiomas of the orbit. Eye Sci. 2011;26(1):48-51. doi: https://doi.org/10.3969/j.issn.1000-4432.2011.01.010.
  5. McNab AA, Tan JS, Xie J, et al. The natural history of orbital cavernous hemangiomas. Ophthalmic Plast Reconstr Surg. 2015;31(2): 89-93. doi: https://doi.org/10.1097/IOP.0000000000000176.
  6. Smoker WR, Gentry LR, Yee NK, et al. Vascular lesions of the orbit: more than meets the eye. Radiographics. 2008;28(1):185-204. doi: https://doi.org/10.1148/rg.281075040.
  7. Khan SN, Sepahdari AR. Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies. Saudi J Ophthalmol. 2012;26(4):373-383. doi: https://doi.org/10.1016/j.sjopt.2012.08.001.
  8. Shields JA, Shields CL. Eyelid, conjunctival, and orbital tumors. An atlas and textbook. 3rd ed. Wolters Kluwer; 2015. 824 p.
  9. Davis KR, Hessellnk JR, Dallow RL, Grove AS. CT and ultrasound in the diagnosis of cavernous hemangioma and lymphangioma of the orbit. J Comput Tomogr. 1980;4(2):98-104. doi: https://doi.org/10.1016/s0149-936x(80)80003-8.
  10. Yan J, Li Y. Unusual presentation of an orbital cavernous hemangioma. J Craniofac Surg. 2014;25(4): e348-349. doi: https://doi.org/10.1097/SCS.0000000000000774.
  11. Rootman DB, Heran MK, Rootman J, et al. Cavernous venous malformations of the orbit (so-called cavernous haemangioma): a comprehensive evaluation of their clinical, imaging and histologic nature. Br J Ophthalmol. 2014;98(7):880-888. doi: https://doi.org/10.1136/bjophthalmol-2013-304460.
  12. Saqui AE, Aggouri M, Benzagmout M et al. Une cause rare d’exophtalmie: l’hémangiome caverneux intraorbitaire (à propos d’un cas). [A rare cause of exophthalmia: intraorbital cavernous hemangioma (about a case)]. Pan Afr Med J. 2017;26:131. doi: 10.11604/pamj.2017.26.131.9808. (In French).
  13. Mortha S. A case of epistaxis? Hemangioma of nose. Otolaryngology Online Journal. 2016;6(2):107.
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  15. Yamamoto J, Takahashi M, Nakano Y, et al. Spontaneous hemorrhage from orbital cavernous hemangioma resulting in sudden onset of ophthalmopathy in an adult – case report. Neurol Med Chir(Tokyo). 2012;52(10):741-4. doi: https://doi.org/10.2176/nmc.52.741.

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2. Fig. 1. Patient G., 67 years old. The appearance of the patient at admission: a – central focus (orthophoria, varicose veins in the right superciliary area (arrows), conjunctival hyperemia of the right eye); b – up gaze (proptosis of the right globe)

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3. Fig. 2. Day-night dynamics of the right eye chemosis: a – chemosis presence in the first half of the day; b – chemosis absence in the evening

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4. Fig. 3. The amplitude of the right eyeball movements. Eye position in up gaze (a), limited mobility by 10°; down gaze (b), to the left (c), to the right (d) mobility restriction by 15° in each of the directions

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5. Fig. 4. Binocular visual field of the patient G. upon admission to the clinic (the double vision area is shown in yellow)

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6. Fig. 5. Scanning laser ophthalmoscopy (retro mode), the upper inner quadrant of the peripheral retina of the left eye. Operculum of the retinal tear in the vitreous (arrow)

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7. Fig. 6. Scanning laser ophthalmoscopy, retro mode. Upper temporal quadrant of the peripheral retina of the left eye: 1 – pigmented nevus; 2 – demarcation line; 3 – retinal detachment

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8. Fig. 7. Fundus photo (а) and scanning laser ophthalmoscopy, retro mode (b). Lower quadrants of the peripheral retina of the left eye. Lattice vitreochorioretinal degeneration (arrows)

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9. Fig. 8. Optical coherence tomography of the peripheral retina of the left eye. Scan through the focus of chorioretinal dystrophy area: 1 – retinal traction with a fixed and compacted vitreous band (2)

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10. Fig. 9. Magnetic resonance imaging T2 WI, axial (a) and sagittal (b) projections. Neoplasm of the right orbit (arrow)

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11. Fig. 10. Computed tomogram of the orbits in the sagittal (a), axial (b) and coronal (с) projections. 1 – suggested location of the upper orbital wall defect, 2 – orbital neoplasm, 3 – band to the orbital neoplasm (arrow)

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12. Fig. 11. Magnetic resonance imaging T2 WI, axial projection. Tumor in the right orbit (1), dilated upper ophthalmic vein (2)

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13. Fig. 12. Angiogram of the right internal carotid artery and the vessels of the right orbit, sagittal projection: a — arterial phase, b — venous phase: 1 – right internal carotid artery. The vessels of the neoplasm (а and b, 3) are fed from the dilated ophthalmic artery (а, 2) with drainage into the right facial vein (b, 4)

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14. Fig. 13. Subtraction angiogram in lateral projection: а – arterial phase, b – venous phase. 1 – right internal carotid artery; 2 – ophthalmic artery; 3 – own vascular network of the neoplasm; 4 – varicose dilated drainage vein opening; 5 – draining facial vein

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15. Fig. 14. Rotational angiogram: a – general appearance in lateral view; b – left-side appearance of vascular network of the tumor; c – right-side appearance of vascular network of the tumor. 1 – ophthalmic artery, 2 – central retinal artery, 3 – proper vascular network of the neoplasm, 4 – draining vein, 5 – vascular network afferents, 6 – varicose dilated drainage vein opening, 7 – arteriovenous fistulas (shunts)

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16. Fig. 15. Dynamics of tumor vascular network embolization by detachable microspirals, and the results of angiography: a and b – dynamics of embolization of the vascular network of the tumor; c – phased angiography through a transvenous microcatheter; d – final result after the injection of the liquid non-adhesive composition ONYX18; e – control angiography, the final result – proper vascular network is not contrasted, the draining vein is not filled. 1 – Target coils, 2 – microcatheter tags, 3 – slowed blood flow through the draining vein, 4 – liquid non-adhesive composition ONYX18 in the draining vein, 5 – ophthalmic artery

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17. Fig. 16. Control angiography of the right internal carotid artery and vessels of the right orbit, sagittal projection: arterial phase (a) and venous phase (b). At the arterial phase (a), the ophthalmic artery is contrasted (2), the vascular network of the neoplasm is not detected. In the cavity of the tumor in both stages of angiography (a and b), radio opaque embolizing microspirals (5) are visualized. At the venous phase (b), there is no outflow from the tumor into the right facial vein (4)

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18. Fig. 17. Dynamics of filling of the vascular network of the orbital neoplasm with contrast according to the results of angiography: a – before embolization: gradual filling of the arterial network of the cerebral vessels and then those of the tumor with the transition to the venous phase; b – after embolization

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19. Fig. 18. Computed tomography after embolization of the proper vascular network of the right orbital tumor. On sagittal (a) and coronal (c) projections, artifacts in the cavity of the embolized neoplasm are visualized (1). On the axial projection (b), a part of an intact (non-embolized) tumor is revealed (2)

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20. Fig. 19. Removal of the orbital tumor

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21. Fig. 20. Band, fixing the tumor

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22. Fig. 21. Removed tumor of the right orbit (1) with elements of embolizing microspirals partially extracted from it (2)

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23. Fig. 22. Histological preparation of the tumor removed from the right orbit. Hematoxylin and eosin stain, magnification ×100 (a), ×200 (b)

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24. Fig. 23. Patient G., 67 years old. The appearance of the patient after surgery, on the 5th day (a), after 6 weeks (b), after 1 year (c)

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25. Fig. 24. Magnetic resonance imaging T1 WI. Images before (a, c) and after (b, d) surgery. 1 – tumor. a, c – parasagittal, b, d – coronal projections

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Copyright (c) 2020 Gorbachev D.S., Kulikov A.N., Svistov D.V., Savello A.V., Kol’bin A.A., Martynov R.S., Leongardt T.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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