Orbito-cranial schwannoma - a multicenter experience
Date
2023
Authors
Shapira, Y.
Juniat, V.
Dave, T.
Hussain, A.
McNeely, D.
Watanabe, A.
Yoneda, A.
Saeed, P.
Woo, K.I.
Hardy, T.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Eye, 2023; 37(1):48-53
Statement of Responsibility
Yinon Shapira, Valerie Juniat, Tarjani Dave, Ahsen Hussain, Daniel McNeely, Akihide Watanabe, Akiko Yoneda, Peerooz Saeed, Kyung In Woo, Thomas G. Hardy, Benjamin Price, Kate Drummond and Dinesh Selva
Conference Name
Abstract
OBJECTIVES: To describe the features, management approaches, and outcomes of orbito-cranial schwannomas. METHODS: Retrospective review of ten patients with orbito-cranial schwannomas managed in six orbital services over 22 years. Data collected included demographics, presenting features, neuroimaging characteristics, histology, management approach, complications, and outcomes. RESULTS: Mean age of the patients was 41.4 ± 19.9 years, and 6 (60%) were females. The majority presented with proptosis (90%), limited extraocular motility (80%), eyelid swelling (60%), and optic neuropathy (60%). Most lesions (80%) involved the entire anterior-posterior span of the orbit, with both intra- and extraconal involvement. All tumours involved the orbital apex, the superior orbital fissure, and extended at least to the cavernous sinus. Surgical resection was performed for all. Seven (70%) of the tumours were completely or subtotally resected combining an intracapsular approach by an orbital-neurosurgical collaboration, with no recurrence on postoperative follow-up (6–186 months). Three underwent tumour debulking. Of these, two remained stable on follow-up (6–34 months) and one showed progression of the residual tumour over 9 years (cellular schwannoma on histology) necessitating stereotactic radiotherapy (SRT) for local control. Adjuncts to the orbito-cranial resection included perioperative frozen section (n = 5), endoscopic transorbital approach (n = 2), and image-guided navigation (n = 1). Post-surgical adjuvant SRT was used in three subjects. CONCLUSIONS: These results highlight the possibility of successful surgical control in complex orbito-cranial schwannomas. A combined neurosurgical/orbital approach with consideration of an intracapsular resection is recommended. Recurrence may not occur with subtotal excision and observation may be reasonable. Adjunctive SRT for progression or residual tumour can be considered.
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Description
Published online: 09 January 2022
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Rights
© The Author(s), under exclusive licence to The Royal College of Ophthalmologists 2021