PMC5733200_01
Preoperative MRI scans. (a) A well-defined tumor (white arrow) with vivid signal intensity in the right orbit. (b) The tumor cannot be separated from the optic nerve, followed by the foramen optic (white arrow). (c) The T2-weighted image shows the exact position and size of the tumor. (d) The dorsal edge of the previous shot.
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He was diagnosed with a right-sided retrobulbar tumor at the ophthalmology department of another medical institution (ophthalmological examination and orbital MRI were performed); however, the ophthalmological team declined to perform the surgical procedure (Figures 1 and 2).
Sagittal T1-weighted MRI. The exact position and extent of the tumor and its relation to the optic nerve are clearly visible. There is a noticeable ocular bulb dislocation (white arrow).
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He was diagnosed with a right-sided retrobulbar tumor at the ophthalmology department of another medical institution (ophthalmological examination and orbital MRI were performed); however, the ophthalmological team declined to perform the surgical procedure (Figures 1 and 2).
Preoperative images. (a) Observe the right exophthalmus, the downward and outward dislocation of the ocular bulb, which places the pupil's axis toward the medial. Hypoglobus and anisocoria (right-sided mydriasis) are clearly visible symptoms. The movements of the ocular bulb are completely blocked cranially and laterally. (b) The previous images with closed eyes. On the right side, the upper eyelid closure is incomplete.
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 Figure 3 illustrates the ophthalmological status of opened eyelid and closed eyelid immediately before surgery.
Intraoperative images. (a) We raise the split Tenon-case with clips. The ocular muscles are elevated by several suture threads. (b) Retrobulbar area filled with the bluish-gray color, encapsulated tumor.
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The tumor had a definite encapsulated and cystic character; however, it clearly showed inhomogeneous gelatinous fragments of solid tumor (Figures 4-6). The skin edges were intracutaneously closed with 4.0 Dafilon stitches (Figures 4-6) (Supplementary Material).
Intraoperative images. (a) By elevating the tumor, we bluntly dissect it carefully from the dorsal surface of the ocular bulb and from the optic nerve. (b) Demonstration of the surgical cavity after successful removal of the tumor.
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The tumor had a definite encapsulated and cystic character; however, it clearly showed inhomogeneous gelatinous fragments of solid tumor (Figures 4-6). The skin edges were intracutaneously closed with 4.0 Dafilon stitches (Figures 4-6) (Supplementary Material).
Intraoperative images. (a) Checking ocular bulb movements and relieving any movement constrictions. (b) End stage of the surgery: wound closure with intracutaneous sutures. We could observe the disappearance of the exophthalmus. The mydriasis appeared to increase, and pupil decentralized.
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The tumor had a definite encapsulated and cystic character; however, it clearly showed inhomogeneous gelatinous fragments of solid tumor (Figures 4-6). The skin edges were intracutaneously closed with 4.0 Dafilon stitches (Figures 4-6) (Supplementary Material).
Images of histopathologic examination of the surgical specimen. (a) Hematoxylin-eosin staining represents a solid tumor with several cells showing a vortical pattern. (b) Tumor cells show intense S-100-specific immunoreaction. (c) The smooth muscular actin- (SMA-) specific immunoreaction is practically negative. (d) The neuron-specific enolase- (NSE-) specific immunoreaction represents a strong granular cytoplasmic positivity.
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Histopathologic examination confirmed the diagnosis of benign glial cell tumor based on the expression of neuron-specific enolase (NSE) and synaptophysin (S-100), while cytokeratin AE1/3 reaction and Mib1 markers were negative (Figure 7).
Postoperative MRI scans (3 months). Axial and coronal T1 (a, c) and T2-weighted (b, d) MRI images show normal anatomical conditions with no residual tumor mass.
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Postoperative follow-up MRI examination revealed no residual tumor (Figure 8).