PMC9349361_01
CT scan of the skull showing a right isodense well-encapsulated orbital lesion (A), displacing the extraocular muscles (B). The arrow indicates the mild bone scalloping of the orbital roof (C,D).
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F1
It presented regular margins and caused mild bone scalloping of the orbital roof (Figure 1).
T2-weighted axial (A) and coronal (B) MRI showing the regular margin of the lesion displacing superior rectus and superior elevator palpebrae muscles medially and lateral rectus muscle inferiorly (thin arrows). Dynamic contrast-enhanced-MRI, the thick arrows indicate the progressive and centripetal enhancement after gadolinium administration (C,D).
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F2
Magnetic resonance imaging (MRi) confirmed lesion at the extraconal compartment, displacing superior rectus and superior elevator palpebrae muscles medially and lateral rectus muscle inferiorly (Figures 2A,B). The lesion presented high signal on T2-weighted images with progressive centripetal contrast enhancement (Figures 2C,D).
Intraoperative images. An endoscopic transorbital superior eyelid approach was performed. Sharp (A) and smooth (B,C) dissection of the CVM from the periorbita, until entire exposure of the lesion is achieved (D). Gentle coagulation of the capsule with bipolar forceps (E). En bloc resection of the CVM (F).
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F3
The periorbita was exposed, slightly opened, and gently retracted with muscles to expose the CMV appearing as a reddish-colored, vascularized and well encapsulated mass (Figures 3A,B). With the use of dissector, curette and bipolar forceps, the lesion's capsule was gently dissected from surrounding structures and isolated from superior orbital fissure and muscles (Figure 3C); then an en bloc resection was successfully achieved (Figure 3D) (Video 1).
Ten days postoperative T2-weighted axial (A) and coronal (B) MRI showing complete resection of the orbital CVM with the globe's re-alignment.
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F4
Post-operative MRI confirmed the gross total removal of the lesion and ocular compression signs were resolved (Figure 4).