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J Neurol Surg B Skull Base 2018; 79(04): 386-393
DOI: 10.1055/s-0037-1612616
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Orbital Apex Lesions: A Diagnostic and Therapeutic Challenge

Sung-Woo Cho
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
,
Won-Wook Lee
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
,
Dae Joong Ma
2   Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
,
Ji-hoon Kim
3   Department of Radiology, Seoul National University Hospital, Seoul, Korea
,
Doo Hee Han
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
,
Hyun Jik Kim
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
,
Dong-Young Kim
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
,
Seong-Joon Kim
2   Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
,
Sang In Khwarg
2   Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
,
Sung-Min Kim
4   Department of Neurology, Seoul National University Hospital, Seoul, Korea
,
Sun Ha Paek
5   Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
6   Center for Minimally Invasive Skull Base Surgery, Seoul National University Hospital, Seoul, Korea
,
Chae-Seo Rhee
7   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnamm, Korea
,
Chul Hee Lee
7   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnamm, Korea
,
Peter H. Hwang
8   Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, United States
,
Tae-Bin Won
1   Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
6   Center for Minimally Invasive Skull Base Surgery, Seoul National University Hospital, Seoul, Korea
› Author Affiliations
Further Information

Publication History

12 September 2017

13 November 2017

Publication Date:
13 December 2017 (online)

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Abstract

Objective To analyze the clinical characteristics of and treatment outcomes for orbital apex lesions according to their pathological diagnosis and identify clinical characteristics that could aid in their differential diagnosis.

Design Retrospective analysis design was used for this study.

Setting The study was conducted in a single tertiary institution.

Participants Patients with pathologically confirmed lesions centered in the orbital apex who were admitted between January 2011 and December 2015.

Main Outcome Measures Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, intraoperative findings, biopsy results, and treatment outcomes.

Results Nine patients with invasive fungal sinusitis, six with inflammatory pseudotumor, and six with neoplastic or tumorous lesions were enrolled. The most common presenting symptom was orbital pain or headache, followed by ophthalmoplegia and vision loss, which exhibited overall recovery rates of 62.5% and 33.3%, respectively, after definitive treatment. The prognosis was worse for patients with invasive fungal sinusitis. There was no significant difference in age, underlying medical conditions, absolute neutrophil count, C-reactive protein level, and radiological findings among the three groups. Grossly necrotic tissues around the orbital apex area at biopsy were more frequently found in patients with invasive fungal sinusitis than in the other patients. In most cases, pain ameliorated after surgical intervention. There were no surgery-related morbidities.

Conclusions Lesions centered in the orbital apex included invasive fungal sinusitis, inflammatory pseudotumor, and tumorous lesions. However, clinical features that clearly differentiated chronic invasive fungal sinusitis from inflammatory pseudotumor could not be identified. Our findings suggest that prompt biopsy is warranted for timely diagnosis, symptom relief, and early implementation of definitive treatment.

Keywords

orbital apex - invasive fungal sinusitis - inflammatory pseudotumor - biopsy - prognosis
 

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