Looking at the Eye through an Imaging Lens: Imaging Characteristics of Orbital Lesions for the Skull Base Surgeon

Objective: The ophthalmologist and otolaryngology surgeons perform their work in highly sensitive areas involving the orbit and surrounding structures. They have to be mindful of the many pitfalls that can occur when operating near the many nerves, vessels, and structures that exit the skull base. The orbit is a particularly sensitive area, with a broad spectrum of pathologies that can compromise the region. Neuroimaging plays an important role in diagnosing these lesions, defining their extent, and guiding surgical approach. It can highlight anatomical features that provide a corridor for surgical access or indicate the need for alternative approaches. Neuroimaging can also play an intraoperative role, for example, in guiding the placement of implants during orbital reconstruction. Orbital imaging includes cross sectional imaging including CT and MRI. Both these modalities play complementary roles in understanding of the orbital anatomy and characteristic imaging findings of various orbital pathologies.

Purpose: The purpose of this exhibit is to provide a framework to classify orbital lesions on imaging, to understand the imaging characteristics of orbital pathologies, and to review anatomical landmarks that necessitate surgical caution.

Methods: We performed a retrospective search of our multi-center radiology database to identify imaging findings across a spectrum of orbital lesions.

Findings: This exhibit will describe the normal anatomy of the orbit and the differential diagnosis for orbital lesions. Orbital imaging findings will be presented alongside a discussion of key diagnostic imaging characteristics and structured approaches to evaluating orbital imaging, with an emphasis on surgical decision-making in the area of the orbit.

Summary: The orbit is a highly sensitive region with enormous implications for health and quality of life. Imaging plays an important role in diagnosis and operative management and can help improve patient outcomes ([Fig. 1]).

Fig. 1 Optic nerve sheath meningioma. On axial T2 (A) and pre-contrast axial T1 (B), there is diffuse mild circumferential thickening of the optic nerve sheath surrounding the optic nerve. The images show circumferential enhancement of the post-contrast coronal T1 (C) and axial (D) images giving a characteristic “tram-track” appearance.

Publication History

Article published online:
15 February 2022