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Orbital neurinoma presenting orbital apex syndrome Shigetaka ANEGAWA 1 , Takashi HAYASHI 1 , Ryuichiro TORIGOE 1 , Kosuke IWASAKO 1 , Norimasa SAKAE 1 , Yoshiyuki OSHIO 2 1Department of Neurosurgery Institute of Neurosciences 2Department of Ophthalmology, St. Mary's Hospital Keyword: orbital neurinoma , orbital apex syndrome , orbital tumor , surgical removal pp.473-477
Published Date 1997/5/10
DOI https://doi.org/10.11477/mf.1436901395
  • Abstract
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A 75-year-old man presented a twelve-day history of double vision and retro-ocular pain with rapid de-terioration of visual acuity. Neurological examination on admission demonstrated right oculomotor palsy and abducence palsy, visual loss in the right eye, and hypesthesia and pain in the right supraorbital nerve.CT scan and MRI disclosed a mass in the right orbital apex.

An emergency operation via a frontotemporal ex-tradural approach was performed to decompress the op-tic nerve. The anterior clinoid process and minor wing of the sphenoid were drilled to expose the optic canal and superior orbital fissure. When the periorbita just beside the optic sheath was opended, a grayish colored mass was observed beneath the superior rectus muscle. The mass was dissected from the surrounding intraor-bital tissue and was removed completely. The postop-erative course was uneventful. The patient experienced complete disappearance of the ocular pain and complete restoration of his visual acuity.

Orbital neurinoma is a benign tumor accounting for between 2.1 and 6.8% of all orbital tumors in the large series. The salient clinical symptom is exophthalmos followed by mass palpability. However, an orbital neurinoma presenting orbital apex syndrome is quite rare. In the case with orbital apex syndrome, it is some-times impossible to recover visual acuity even though the optic nerve decompression is promptly performed.In such a case, only an emergency approach to the le-sion can rescue the visual acuity.


Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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