Immunocytologic methods in the diagnosis of orbital tumors.
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Biopsy↗
Biomedical subjects
J S Kennerdell
Publications and source records attributed to J S Kennerdell.
Optic nerve sheath meningiomas. Clinical manifestations.
A retrospective clinical study of optic nerve sheath meningiomas based on 22 patients showed that symptoms most commonly develop in women between the ages of 35 and 60 years. The most common presenting symptoms were decreased vision and transient visual obscurations. In the earliest stages, many patients presented with normal to mildly impaired acuity (despite subjectively decreased vision), optic disc edema and enlargement of the blind spot. Optic disc edema was frequently associated with refractile bodies indicative of chronic swelling. Optic disc edema preceded the development of optic atrophy. Another group of patients presented with a history of longstanding vision loss, visual acuity of 20/200 or worse and optic atrophy. Optociliary shunt vessels were late findings only seen in five patients. The most consistent visual field abnormality was peripheral constriction. Cecocentral scotomas were uncommon. Intracranial involvement was present in five patients. There were two patients with bilateral optic nerve sheath meningiomas without CT evidence of intracranial involvement. Computerized tomography was found to be indispensable in the diagnosis of optic nerve sheath meningiomas and the detection of intracranial involvement.
Adolescent↗
Combined clinical and computed tomographic diagnosis of orbital glioma and meningioma.
The clinical information on 22 patients with orbital optic nerve gliomas and 47 patients with meningiomas was correlated with computed tomographic findings obtained in both axial and coronal studies. Most of the gliomas occurred in children, although 7 patients presented after 20 years of age. Among the patients with meningiomas, the majority were women in early middle age, although two tumors occurred in children less than 20 years of age. Low grades of proptosis (median, 2 mm for both tumors), frequent significant visual field obscurations with eye movements, and opto-ciliary shunt vessels pointed toward the diagnosis of an optic nerve tumor. Patients with gliomas generally manifested massively swollen fusiform optic nerves with clear-cut margins due to circumscription by an intact dura. Kinks and bucklings of the optic nerve as well as infarctive cysts distinguished the glioma CT-scan patterns from the meningiomas. Distinctive axial CT-scan features of the meningiomas not shared by the gliomas were narrowly and diffusely enlarged nerves with polar expansions either at the orbital apex or immediately behind the globe; calcification; irregular excrescent margins signifying extradural invasion into the orbital soft tissues; a negative optic nerve shadow running down the center of the lesion; and bone erosion near the orbital apex. Coronal studies often revealed irregular margins signifying transgression of the dura. A diffusely and narrowly enlarged optic nerve shadow with regular margins (intrasheath lesions) was the one morphologically overlapping pattern displayed by 11 meningiomas and three gliomas. In these cases there tended to be more profound visual loss in the gliomas compared with the meningiomas, as well as the more frequent presence of opto-ciliary vessels in the meningiomas. Arteriography may be helpful in this particular category by demonstrating a tumor blush for the meningiomas, whereas this finding is typically absent with optic nerve gliomas. Meningiomas may be very closely simulated by dural or intraneural inflammations.
Adolescent↗
Optic nerve/sheath enlargement. A differential approach based on high-resolution CT morphology.
A wide variety of neoplastic and non-neoplastic processes can cause the intraorbital optic nerve and sheath to be enlarged on CT. The authors reviewed a large number of high-resolution CT scans and divided enlargement into three groups: tubular, fusiform, and excrescent. Further subdivision was possible by determining whether distinct optic nerve lucency was present or absent.
Cranial Nerve Neoplasms↗
Computed tomography of orbital myositis.
The computed tomographic (CT) scans of 11 consecutive patients with orbital myositis were reviewed to better characterize the CT appearance of this condition. The findings in this series differed from those of previous reports in several ways. Multiple muscle involvement predominated. Bilateral involvement was more frequent than previously reported. Enlargement of the tendon as well as the muscle was a frequent finding, but a normal tendinous insertion did not preclude the diagnosis of orbital myositis. Although the CT appearance of orbital myositis is often helpful, the findings are not pathognomonic; correlation with history, clinical findings, and therapeutic response must be considered in making the diagnosis.
Adult↗
Surgical approaches to the orbit. Indications and techniques.
The authors review their experience with over 300 patients with orbital tumors, and summarize their surgical techniques and indications for each surgical approach. A fronto-orbital approach is described which is used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral micro- orbitotomy is used for tumors located in the superior, temporal, or inferior compartment of the orbit and those in the lateral apex. A medial microsurgical approach is used for tumors located medial to the optic nerve but not deep in the apex. By thus approaching tumors directly, optimal exposure is obtained and functional deficits are minimized. The pertinent surgical anatomy is illustrated and the technique of fine-needle aspiration biopsy is discussed.
Biopsy, Needle↗
Extraocular muscle surgery for dysthyroid myopathy.
A series of 45 patients underwent extraocular muscle surgery for diplopia induced by dysthyroid myopathy. Two thirds (31) of the patients were female and age distribution showed a peak (47%) in the sixth decade of life. The most common deviation was pure hypotropia; a combination of hypotropia and esotropia was also frequent. Initial surgical intervention restored binocularity in primary position in 30 patients and in reading position in 27 patients. After further surgery in some cases, 40 patients eventually achieved satisfactory alignment in primary position and 36 achieved it in reading position.
Adult↗
Acute and subacute orbital myositis.
Of 12 consecutive patients (nine women and three men ranging in age from 18 to 70 years) with orbital myositis, four had histories of ocular or systemic autoimmune disease. Five patients treated within two weeks of developing acute orbital pain and extraocular muscle dysfunction were classified as having acute myositis. They responded to corticosteroids within 72 hours although three had single recurrences during six- to 16-month follow-up periods. No patients were heterotropic or proptotic at the final examination. Seven patients with less severe or atypical symptoms who had delays of two or more months between onset and treatment were classified as having subacute myositis. All had recurrences with five having two or more. Three required supplemental radiation therapy during seven- to 20-month follow-up periods. At the final examinations, six patients had motility defects and one had proptosis, indicating that delays in treatment may lead to recurrences, extraocular muscle dysfunction, and proptosis.
Acute Disease↗
B-scan ultrasonic evaluation of a dilated superior ophthalmic vein in orbital and retro-orbital arteriovenous anomalies.
All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography. Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations). On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein. None of the other patients with unilateral proptosis demonstrated this finding. With recent advances in treatment of these conditions, early diagnosis becomes increasingly important. Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas. Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein. In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results.
Adult↗
Orbital metastasis of bladder carcinoma.
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Carcinoma↗
Fixed dilated pupil resulting from transdermal scopolamine.
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Administration, Topical↗
Primary idiopathic inflammation of the optic nerve.
A 50-year-old woman with progressive right-sided visual loss had severely reduced visual acuity in the right eye and an upper temporal visual field defect in the left eye. Extensive neuroradiologic studies disclosed an enlarged right optic nerve, and a transfrontal craniotomy. Biopsy of the right optic nerve showed perivascular lymphocytic infiltration and a few atypical astrocytes. A complete medical evaluation gave no evidence of systemic vasculitis or lymphoreticular malignancy. Oral corticosteroids were administered for two months, and no further deterioration of vision occurred. Two years later, although the right eye was blind, the visual acuity of the left eye was 6/2 (20/20), and the patient had no clinical or radiologic evidence of optic chiasm tumor.
Adrenal Cortex Hormones↗
An orbital decompression for severe dysthyroid exophthalmos.
A procedure has been developed for maximizing decompression in patients with nonspecific orbital inflammatory disease or dysthyroid orbitopathy that involves removal of parts of all four orbital walls through a lateral orbitotomy using a 30-mm incision combined with a canthotomy and an inferior cul-de-sac incision. The procedure has been performed on seven orbits of four patients who had greater than 30 mm of forward placement of the eyes as measured by Hertel exophthalmometry and/or a 10-mm difference in the forward placement of the two eyes, indications considered for this procedure. The procedure has resulted in 10-17 mm of reduction in proptosis in these patients, which is consistently greater than that obtained by any other procedure. A complication of spinal fluid leak resulted in the recommendation that the procedure not be performed in patients over 65 whose dura is considered too thin to prevent spontaneous leakage and minimal surgical trauma. In all circumstances, this procedure must be performed by an experienced neuro-ophthalmic orbital surgical team.
Adult↗
Computed tomographic scanning or orbital tumors.
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Adolescent↗
Evaluation of orbital cellulitis and results of treatment.
Optimal management of patients with orbital cellulitis depends on how accurately the disease is classified and on the appropriateness with which antibiotics and surgery are used to treat the disease. Therapy must be adjusted on the basis of the extent of the disease. In order to determine the balance of treatment modalities which is most beneficial for certain disease presentations, we reviewed a series of 303 patients with orbital cellulitis. The anatomical and bacteriological etiology of the disease was determined in each case on the basis of the examination, visual acuity, results of sinus radiography, results of culture, ultrasonography, and computerized tomography. To avoid the 5% complication rate that occurred in this series, an evaluation and treatment protocol is recommended.
Abscess↗
Radical orbital decompression for severe dysthyroid exophthalmos.
A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated wih corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.
Adult↗
Cemento-ossifying fibroma of the ethmoidal sinus manifesting as proptosis.
We report an aggressive cemento-ossifying fibroma of the ethmoidal sinus that initially manifested as proptosis and was misdiagnosed as meningioma after a frozen section was tested. Fibroosseous lesions containing cementum are considered to be of periodontal membrane origin and are most common in the mandible and maxilla. With the exception of the gigantiform cementoma, they are usually small, innocuous lesions following a benign course and are easily removed surgically. On rare occasions, the cemento-ossifying fibroma attains a large size, behaves aggressively, destroys bone, and requires radical surgery for complete excision. Such behavior appears likely when is is located in unusual sites such as the ethmoidal sinus. To our knowledge, our case is the third report of a cemento-ossifying fibroma arising in the ethmoidal sinus. Aggressive behavior has been a feature in all three instances.
Ethmoid Sinus↗
Progressive visual loss due to glioblastoma: normal neuroroentgenorgraphic studies.
A case of progressive bilateral visual loss of abrupt onset an rapid course is described. Extensive neurorentgenographic evaluation was normal, and the results of exploratory craniotomy were unremarkable, except for a slight ovality of the left optic nerve. A biopsy of the left optic nerve showed a glioblastoma, apparently originating in the anterior optic pathways.
Blindness↗