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Orbital apex venous cavernous malformation with optic neuropathy: treatment with multisession gamma knife radiosurgery
  1. Stephanie Ming Young1,
  2. Kyung Hwan Kim2,
  3. Yoon-Duck Kim3,
  4. Stephanie S Lang4,
  5. Ji Woong Park3,
  6. Kyung In Woo2,
  7. Jung-Il Lee2
  1. 1 Department of Ophthalmology, National University Hospital, Singapore, Singapore
  2. 2 Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  3. 3 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  4. 4 Clinical Audit, Singapore National Eye Centre, Singapore, Singapore
  1. Correspondence to Yoon-Duck Kim, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea; yoonduck.kim{at}samsung.com; Professor Jung-Il Lee, Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea; jilee.lee{at}samsung.com

Abstract

Purpose To evaluate the efficacy and safety of multisession gamma knife radiosurgery (GKRS) for orbital apex venous cavernous malformation causing optic neuropathy.

Methods Retrospective cohort study in a single tertiary institution from January 2007 to December 2016 on patients who underwent multisession GKRS for orbital apex venous cavernous malformations causing optic neuropathy.

Results There were 12 patients included in our study. The mean age was 40.2±14.5 years, and men comprised 66.7% (n=8). Decrease in visual acuity (83.3%) was the most common symptom at presentation. The mean clinical follow-up was 28.5 months. Ten (83.3%) of the 12 patients had improvement in best corrected visual acuity. Of the 10 patients with pre-existing relative afferent pupillary defect (RAPD), 6 (60%) had complete resolution of RAPD. Of the 12 patients with visual field defect, 7 (58.3%) had complete resolution, 3 (25%) had partial improvement, while 2 (16.7%) remained unchanged due to optic atrophy from long-standing compressive optic neuropathy. Mean proptosis reduced from 2.3±1.7 mm pre-GKRS to 0.5±1.3 mm post-GKRS (p=0.005). Tumour shrinkage was observed in all patients. The mean tumour volume at the time of GKRS was 3104 mm3 (range 221–8500 mm3), which reduced to 658 mm3 (range 120–3350 mm3) at last follow-up. None of the patients experienced GKRS-related ocular morbidity during the follow-up period.

Conclusion Multisession GKRS has shown to be an effective and safe option for the treatment of orbital apex venous cavernous malformations causing optic neuropathy, with significant improvement in ophthalmic outcomes and reduction in tumour volume.

  • orbit
  • cavernous hemangioma
  • venous cavernous malformation
  • optic neuropathy
  • gamma knife
  • radiosurgery
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Footnotes

  • SMY and KHK are joint first authors.

  • Contributors All authors have made substantial contributions to the (1) conception of the work, (2) the acquisition, analysis or interpretation of data, (3) drafting the work or revising it critically for important intellectual content, and (4) final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The manuscript has been read and approved by all the authors, and the requirements for authorship as stated above have been met.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by Samsung Medical Center Ethics Committee/Institutional Review Board (IRB No SMC2017-10-068) and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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