Transnasal endoscopic removal of orbital apex cavernous hemangioma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the strategy and indications of endoscopic transnasal resection of orbital apex cavernous hemangiomas (OACH).</p><p><b>METHODS</b>Eleven patients aged from 30 to 62 years-old diagnosed as OACH bypostoperative histopathology were reviewed retrospectively. Four males and 7 females were included. Both ophthalmological examination and rhinologic evaluation were adopted preoperatively. The surgeries were carried out under general anesthesia endoscopically by the same senior surgeon. After ethmoidectomy, the orbital lamina papyracea was opened, and the orbital fat and muscles were pushed back into the orbit by using the brain cotton, and then the orbital tumor was removed. The patients were kept follow-up both in ophthalmologic and rhinologic departments.</p><p><b>RESULTS</b>As suggested by preoperative imagings, 4 lesions located in the extraconal space (nasal side), 6 between the optic nerve and the internal rectus muscle of the intraconal space, and 1 outside the optic nerve in the intraconal space. Total resection was achieved in 9 cases, and orbital decompressions were done in 2 cases. Meanwhile, orbital wall reconstruction was done in 7 cases. The follow up ranged from 6 to 47 months. Seven patients achieved visual acuity improvement and no deteriorations were found in other 4 patients. Defects of vision field in 3 patients disappeared after 2 weeks. No operative or postoperative complications occurred.</p><p><b>CONCLUSIONS</b>The OACH located in the nasal side of extraconal space and between the optic nerve and the internal rectus muscle of the intraconal space can be accessed endoscopically by intranasal approach. Using the brain cotton to push the orbital fat and muscles back into the orbit and an experienced endoscopic surgeon are important to access a successful intranasal endoscopic removal of orbital apex tumor.</p>

Expression of TGF-β1 protein in orbital bone after enucleation with placement of an orbital implant / 中华实验眼科杂志

Background Placement of an orbital implant is a main way to prevent orbital atrophy with aging.But its mechanism is under clear.Researchs showed that bone growth factors play important role during the development and repair of bone,especially transforming growth factor-β1(TGF-β1).Objective Present study was to investigate the expression of TGF-β1 protein in orbital bone after enucleation or enucleation with placement of an orbital implant and its function in the mechanisms of preventing and treating the orbital malformed development after enucleation with placement of an orbital implant.Methods Twenty-one age- and weight-matched New Zealand white young rabbits were randomly divided into the enucleation,implant and control groups,and each group including seven rabbits.Eyeball nucleation surgery was performed in the left eyes of 7 1-month-old rabbits,and a spherical orbital implant was inserted after enucleation of the left in matched rabbits in implant group.The left eye of normal rabbits served as controls.The rabbits were sacrificed in 1 month after surgery.The expression of TGF-β1 protein in the left orbital bone was detected using enzyme immunoassay and FITC labelling immunoassay technique in the sections of zygomatic bones.The content of TGF-β1 protein in the left orbital bone tissue was measured by ELISA method.This use of animals complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results The height and width of orbital in enucleation group were significantly lower than those of implant and normal control groups(height:P=0.00,P=0.00;width:P =0.00,P=0.00).The positive bone cells of both enzyme immunoassay and FITC staining were increased in the implant and control groups in comparison with enucleation group,but the positive response intensity for TGF-β1 was resembled between implant group and control group.ELISA result revealed that the content of TGF-β1 protein in bone tissue was significantly lower in the enucleation group than in implant and control groups(P=0.00,P=0.00).The expression and content of TGF-β1 protein in bone tissue is similar between the implant group and the control group(P=0.41). Conclusion The experiment results indicate that TGF-β1 protein participate in the orbital development.TGF-β1 played important role in the prevention and treatment of enucleation-induced orbital malformation in the eye with placement of an orbital implant.

Sphenoid wing meningioma en plaque: report of 37 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sphenoid wing meningioma en plaque is a special morphological subgroup of intracranial meningiomas, defined by a carpet-like, soft tissue component that infiltrates the dura and invades the sphenoid wing and orbit associated with a significant hyperostosis. This report summarized our experiences in 37 patients with sphenoid wing meningioma en plaque who had been treated with transcranio-orbital approach surgery.</p><p><b>METHODS</b>A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in 37 patients undergoing transcranio-orbital approach from Sep. 1998 to Apr. 2009. Patients ages: 16 years to 67 years, 45.5 years in average; sex: 15 males, 22 females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated.</p><p><b>RESULTS</b>Simpson grade II resection was achieved in 9 patients, Simpson grade III in 22 patients and Simpson grade IV in 6 patients. Pathological examination showed 27 (73%) patients were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in 18 patients (69%). Temporary ophthalmoplegia was found in 8 patients, cerebrospinal fluid leak was found in 1 patient. Duration of follow up was from 3 months to 9 years, tumor recurred in 7 patients, and 5 patients underwent second surgery, including two trans-nasal endoscopic surgeries to resect sphenoid sinus-involved tumor. There were no operation-related deaths or other significant complications.</p><p><b>CONCLUSIONS</b>Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are more likely to produce adjacent hyperostosis and have characteristic radiological appearances. All the hyperostosis bone of the great wing of sphenoid bone should be removed to prevent recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome. Close co-operation between the neurosurgeons and the ophthalmologists is important.</p>

Transcranial approach for resecting spheno-orbital meningiomas / 眼科

Objective To explore the effect and safety of transcranial approach for spheno-orhital meningioma. Design Retro- spective case series. Participants Thirty-two patients being operated with transcranial approach. Twenty-four cases were meningothelial meningiomas, 3 cases were fibrous meningiomas, 1 case was psammomatous meningioma, 2 cases were atypital meningiomas, 2 case were malignant meningiomas. Methods All patients underwent frontal-temporal craniotomy, the involved sphenoid wing bone and peri- orbit were removed to prevent recurrence. The superior orbital fissure and optic canal were decompressed, the dural and periorbital de- feet were repaired by autogenous temporal fascia or artificial dura. Main Outcome Measures Preoperative and postoperative exoph- thalmus and eyeball movement, the extent of tumor resection, the ratio of recurrence. Results The extent of tumor resection: 8 cases were Simpson gradeⅡ, 20 cases Simpson gradeⅢ, 4 cases Simpson grade IV. After surgery, proptosis were improved in all patients, ophthalmoplegia was found in 6 eases. There was no operation-related death or other significant complication. Tumor recurred in 6 cas- es. Conclusions Adequate exposure of the tumor and bony decompression of the cranial nerves can result from transcranial approach, all the involved bone should be removed in order to prevent recurrence. This approach is relatively safe and the ptoptosis are improved significantly. Complete surgical resection is difficult because of the involvement of the orbital apex, superior orbital fissure and cav- ernous sinus.

Radiological findings of hemangioendotheliomas in the orbit / 中华放射学杂志

Objective Radiological findings of very rare hemangioendotheliomas in the orbit have not been reported.Radiological findings on different imaging studies of four cases with hemangioendotheliomas in the orbit were described and the literature was reviewed so as to understand features of hemangioendotheliomas in the orbit.Methods CT and MR imaging findings of four cases with hemangioendotheliomas in the orbit confirmed by histopathology were analyzed retrospectively.Results A mass was found in the superotemporal quadrant in the anterior extraconal space of the orbit in three cases and in the inferonasal quadrant in one case. CT studies revealed a homogeneously ovoid tumor with benign remodeling of the adjacent bone in three cases and a homogeneously irregular mass without any bony change in one case.MR imaging showed a mass in the orbit that was mildly hypointense on T_1-weighted sequences and hyperintense on T_2-weighted images with areas of flow voids representing vessels within the peripheral portion of the tumor in four cases.All four patients demonstrated significant enhancement immediately after intravenous administration of contrast material and a type D time-signal intensity curve (TIC)pattern on MR dynamic contrast enhancement scanning.Conclusions Hemangioendotheliomas in the orbit appeared as a hypervascular tumor predominantly in the extraconal space with areas of flow voids within the tumor and early significant enhancement of the tumor after intravenous administration of contrast material.MR imaging is the best method in demonstration of features of hemangioendotheliomas in the orbit and in diagnosis of these tumors.

Value of Seeking Tumor Cells Through Cerebrospinal Fluid in Retinoblastoma / 实用儿科临床杂志

Objective To explore the value of seeking tumor cells through cerebrospinal fluid in the metastasis and prognosis of retinoblastoma.Methods Two hundred and fifty-six cases clinic diagnosed retinoblastoma were collected,154 cases were boys and 102 cases were girls.There were 85 children with bilateral disease and 171 children with unilateral disease.Lumbar puncture was examined before treatment,compare the result and prognosis.Children who were found tumor cells in their cerebrospinal fluid were treated with 6 to 9 cycles of systemic chemotherapy with CTV(carboplatin,teniposide and vincristine)protocol and 8 to 10 intrathecal injections with cytrarabine,methotrexate and dexametha-sone.Follow-up were between 8 to 23 months,the mean time was 14.6 months.Results There were 8 cases found tumor cells in their cerebrospinal fluid in all 256 children,one of them died of wide spread intracranial metastasis;the other patient was given high dose chemotherapy with autologous perip-heral stem cell transplantation(APBSCT) because of intracranial metastasis,follow-up to now the patient′s condition was stable.The rest 6 children were enucleated in follow-up period,there were 4 cases(67%) with the histopathology of the eye indicates spread of tumour cells beyond the lamina cribrosa,and 2 cases with invading the cut end of the optic nerve.Six children were no metabasis evidences at other tissues.Conclusions Intracranial metastasis is the common metastasis style in retinoblastoma,so lumbar puncture to seeking tumor cells was important to evaluate intracranial metastasis,early treatment and prognosis.