Infraorbital approach for retrobulbar orbital neurofibroma: a case report
Keywords:Infraorbital approach, Retrobulbar orbital tumor, Neurofibroma
Retrobulbar orbital tumours are rare and treatment is challenging. These tumors include cavernous hemangioma, neurofibroma, A-V malformations, glioma etc. A variety of approaches have been used in resection of these tumours. The various approaches in literature include endoscopic transethmoidal and sphenoidal, lateral orbitotomy, transmaxillary infraorbital, and cranial and sub cranial approaches. Such tumours located inferior to the optic nerve can be reached through infraorbital approach avoiding traction on optic nerve or pressure on globe. We are reporting a retrobulbar orbital neurofibroma in a middle aged lady who presented with unilateral loss of vision, episodic giddiness, severe left sided headache, left orbital pain and epiphora on exposure to sunlight. MRI showed well defined 1.8×1.8×1.7 cm enhancing lobulated solid left intraorbital mass extending along the substance of inferior aspect of left optic nerve with mass effect. With transmaxillary infraorbital endoscope assisted approach, the retrobulbar tumor was exposed and enucleated. Floor of orbit was reconstructed with tensor fascia lata and nasal septal cartilage graft. The patient had uneventful recovery and immediate post operative visual acuity was perception of light and likely to improve further. Histopathology revealed neurofibroma. This case report highlights the advantages of infraorbital approach as it is a simple approach along the suture lines through the orbital floor with the help of endoscopic guidance. It has the advantages of avoiding traction on optic nerve or optic chiasma, no retraction of brain, no communication with cranial cavity, no pressure on globe and easy reconstruction of orbital floor.
Braich PS, Donaldson JC, Bajaj GS, Bearden WH. Isolated neurofibroma of the orbit: case report and literature review. Ophthalmic Plast Reconstr Surg. 2018;34(1):1-6.
Brusati R, Goisis M, Biglioli F, Guareschi M, Nucci P, Gianni AB et al. Surgical approaches to cavernous haemangiomas of the orbit. Br J Oral Maxillofac Surg. 2007;(6):457-62.
Zhang X, Tabani H, El-Sayed I, Russell M, Feng X, Benet A. The endoscopic endonasal transmaxillary approach to Meckel's Cave through the inferior orbital fissure. Oper Neuro Surg (Hagerstown). 2017;(3):367-73.
Arai Y, Kawahara N, Yokoyama T, Oridate N. Endoscopic transnasal approach for orbital tumors: a report of four cases. Auris Nasus Larynx. 2016;43(3):353-8.
Shin M, Kondo K, Hanakita S, Suzukawa K, Kin T, Shojima M, et al. Endoscopic transnasal approach for resection of locally aggressive tumors in the orbit. J Neurosurg. 2015;123(3):748-59.
Har-El G. Combined endoscopic transmaxillary-transnasal approach to the pterygoid region, lateral sphenoid sinus, and retrobulbar orbit. Ann Otol Rhinol Laryngol. 2005;114(6):439-42.
Park SJ, Yang JW. The transconjunctival approach a minimally invasive approach to various kinds of retrobulbar tumors. J Craniofac Surg. 2013;24(6):1991-5.
Karkas AA, Schmerber SA, Bettega GV, Reyt EP, Righini CA. Osteoplastic maxillotomy approach for infraorbital nerve schwannoma, a case report. Head Neck. 2008;30(3):401-4.
Bianca Kenyon BS, Jastin L, Antisdel MD. Anatomic evaluation of endoscopic transnasal transorbital approach to the lateral orbital apex. Am J Rhinol Allergy. 2014;28(1):82–5.
Wu W, Selva D, Jiang F, Jing W, Tu Y, Chen B, et al. Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas. Am J Ophthalmol. 2013;156(3):593-9.
Yoshimura K, Kubo S, Yoneda H, Hasegawa H, Tominaga S, Yoshimine T. Removal of a cavernous hemangioma in the orbital apex via endoscopic transnasal approach: a case report. Minim Invasive Neurosurg. 2010;53(2):77-9.
Chen Y, Tu Y, Chen B, Shi J, Yu B, Wu W. Endoscopic transnasal removal ofcavernous hemangiomas of the optic canal. Am J Ophthalmol. 2017;173:1-6.
Muscatello L, Seccia V, Caniglia M, Sellari-Franceschini S, Lenzi R. Transnasal endoscopic surgery for selected orbital cavernous hemangiomas: our preliminary experience. Head Neck. 2013;35(7):E218-20.