GIANT INTRACONAL CAVERNOUS HEMANGIOMA SUCCESSFULLY REMOVED BY LATERAL ORBITOTOMY -- A CASE REPORT AND REVIEW OF THE LITERATURE

藉由外側眼窩切開術移除巨大肌錐內海綿狀血管瘤──病例報告及文獻回顧

林俊賢(Chun-Hsien Lin) ； 沈應誠(Ying-Cheng Shen) ； 王俊元(Chun-Yuan Wang) ； 吳靜怡(Chin-I Wu) ； 魏利真(Li-Chen Wei)

《中華民國眼科醫學會雜誌》 54卷 (2015/10) Pp. 54-59

https://doi.org/10.30048/ACTASOS.201510_54.0009

摘要

目的：報告一名以凸眼及間歇頭痛為症狀表現的巨大海綿狀血管瘤之病例。方法：病例報告。結果：一位33歲男性，因右眼凸出及間歇頭痛一個月至門診就診。此外，他曾因頭痛接受腦部核磁共振檢查並意外發現右側眼窩內腫瘤。患者右眼視力6/4，左眼視力6/5。凸眼計檢查右眼21.5公釐，左眼20.5公釐。患者並沒有色覺異常，視野缺損或相對性瞳孔光反射缺損。眼眶電腦斷層顯示右側眼眶一多分葉、邊界清晰、18公釐大、不均質顯影的腫瘤。藉由外側眼窩切開術移除腫瘤，組織學鏡檢顯示腫瘤內含大小不一的血管以纖維組織相隔。診斷為海綿狀血管瘤。術後追蹤其間，患者並無明顯不適，術後6個月患者也無復發徵兆或頭痛、凸眼之症狀。結論：雖然大部分眼窩海綿狀血管瘤患者臨床表現為凸眼或無症狀，但有一定比例的患者也可能以頭痛或眼窩疼痛表現。除了依據臨床表現外，我們也可以以典型的電腦斷層或核磁共振影像來確認診斷。而當患者有臨床症狀表現時，則建議手術移除腫瘤。

並列摘要

Purpose: To report a case of a patient with a huge intraconal cavernous hemangioma who presented with proptosis and intermittent headache. Method: Case report Results: A 33-year-old male presented to our clinic with a prominent right eye and intermittent headache, which had lasted for 1 month. He received brain MRI at a local hospital which accidentally revealed a right orbital tumor. His visual acuity was 6/4 OD and 6/5 OS. Right eye proptosis was noted by Hertel exophthalmometry (21.5mm OD, 20.5mm OS). There was no abnormal color sense, relative afferent pupil defect or visual field defect. Orbital CT was arranged and it revealed a well-defined lobulated mass lesion about 18mm in diameter with heterogeneous enhancement over the right orbit. Tumor excision through lateral orbitotomy was performed successfully. Microscopic examination showed tumor content with vascular channels of varying size separated by fibrous connective tissue. The diagnosis was cavernous hemangioma. The postoperative period was uneventful, and the patient was doing well at the 6 month follow-up without headache, proptosis or local recurrence. Conclusion: Although most patients with orbital cavernous hemangiomas present with proptosis but without symptoms, a certain proportion of patients can also present with headache or periorbital pain. Except clinical presentation, diagnosis can be confirmed by typical CT or MR images. A surgical approach is indicated when the lesions become symptomatic.

並列關鍵字

cavernous hemangioma ； orbitotomy