Biomedical subjects
Publications and source records attributed to J S Kennerdell.
We report a case of thyroid carcinoma metastatic to the globe. In our survey we found thyroid carcinomas to metastasise to the eye rarely. In addition, we found metastases from the thyroid to be more common to the orbit than to the globe--a reverse of the pattern noted with tumours in general.
Fine needle aspiration biopsy techniques have recently been applied to the evaluation of orbital masses. Ultrasound and CT examination have been useful in accurately localizing and characterizing such lesions prior to biopsy. Small retrobulbar tumors may be difficult to biopsy using blind needling, despite accurate localization. Preliminary studies on cadaver orbits confirmed that successful biopsy of the normal optic nerve could be accomplished using direct CT guidance. The technique was applied to 2 patients with monocular blindness due to small infiltrating optic nerve tumors and a histologic diagnosis was obtained in each case. This low morbidity procedure though applicable to only a small group of patients may spare them the morbidity of an orbitiotomy or craniotomy.
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A 48-year-old woman with a primary intraorbital meningioma associated with the optic nerve sheath underwent a microsurgical removal of the tumor through a lateral orbitotomy. Visual recovery was essentially complete.
Two women, one with Hodgkin's disease and the other with no malignancy, developed herpes zoster with optic neuropathy and total ophthalmoplegia. Both patients developed an associated mild meningoencephalitis with a predominantly lymphocytic spinal fluid reaction that cleared spontaneously. The patient with Hodgkin's disease suffered a protracted course of the disease and developed a secondary bacterial endophthalmitis that necessitated an envisceration of the left eye. The patient without evidence of immunologic deficit recovered quickly with administration of corticosteroids.
Two cases of dysthyroid orbital diseases are presented which on CT scan had the characteristic appearance of intraorbital tumors. An operation was performed on one of these patients based on the CT scan appearance. This entity should not be confused with true intraorbital neoplasms. One must not rely exclusively on the CT scan in questionable cases as with any other ancillary diagnostic acid and one must bear in mind that dysthyroid disease in evolution may exactly mimic the CT scan appearance of an intraorbital tumor.
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The visually evoked potential (VEP) was recorded from the scalp overlying precentral and occipital cortex in three monocularly deprived humans. The subjects had defects of the globe from birth that effectively created a condition of diffuse light rearing in one eye. In subject, BER, a 19-year-old with a recently removed congenital cataract, the occipital response evoked from the deprived eye was reduced by 53% compared with the response evoked from the good eye. In subject GUZ, age 20 with a congenital cataract, the occipital response evoked from the deprived eye was actually larger by 20% than was the response evoked from the good eye. For UTZ, age 5 with whitish cellular debri in the anterior vitreous of the eye, the occipital response evoked from the deprived eye was only 4% smaller than the response evoked from his good eye. In all three subjects, the precentral response evoked from the deprived eye was reduced in amplitude compared with the precentral response evoked from the good eye. In terms of relative effect of the deprivation upon the VEP from the two recording sites, the precentral VEP was altered to a greater extent than was the occipital VEP. These findings indicate that diffuse light rearing can affect the pathways projecting to precentral cortex independently of the specific visual pathways.
Ten suspected suprasellar mass lesions were evaluated by CT cisternography (CTC). In each case the cisterns could be defined. Suprasellar mass lesions were found in six. Precise assessment of the anterior, lateral, posterior, and superior extent, made by metrizamide CTC, was verified at surgery. In two masses the intravenously enhanced scan was not diagnostic, while a lesion was visualized by intrathecal (metrizamide) CT. The major diagnostic entity was an enlarged third ventricle. When a chiasmic lesion is suspected and the conventional scan is negative, metrizamide CTC is the examination of choice.
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A case of indirect trauma to the optic nerve was successfully treated with transethmoidal decompression. The literature was reviewed, and reports of poor results from neurosurgical procedures are cited. Improved results from transethmoidal decompression of the optic nerve have been reported by Japanese authors but, in our opinion, without proper selection of cases. Early diagnosis of traumatic compression of the intracanalicular optic nerve as evidenced by delayed and/or progressive vision loss following injury, coupled with prompt transantral-ethmoidal surgical decompression, should yield gratifying results in the treatment of this uncommon condition.
We believe that, with the modified Krönlein lateral orbitotomy microsurgical approach, most orbital tumors can be successfully removed with reduced morbidity and complications, compared with the frontotemporal craniotomy or the standard Krönlein lateral orbitotomy. The cosmetic result is quite satisfactory, and the hospital stay should be brief. The use of the operating microscope and the specifically designed and modified instruments for retraction and dissection in the orbit, combined with the efficiency of the self-irrigating bipolar coagulating forceps, add a new dimension to the safety and efficiency of orbital surgery.
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A patient with an intracanalicular meningioma is presented who had the clinical symptoms and signs of optic papillitis. All neuroradiologic examinations except for hypocycloidal polytomography of the optic canals were normal. Orbital pain, progressive decreasing visual acuity, visual fields showing an enlarging scotoma, and a failure to respond to steroid therapy or worsening of symptoms upon steroid withdrawal should alert the clinician to this diagnostic possibility despite normal radiographic studies.