Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic radiosurgery for orbital cavernous venous malformation: a single center’s experience for 15 years

  • Original Article - Tumor - Other
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Stereotactic radiosurgery such as Gamma Knife radiosurgery (GKRS) has been shown to have a good treatment effect for orbital cavernous venous malformation (CVM). However, radiation-induced retinopathy or optic neuropathy is a vision-threatening complication of orbital irradiation. Predicting the post-treatment visual outcome is critical.

Methods

Clinical and radiological outcomes were investigated in 30 patients who underwent GKRS for orbital CVM between July 2005 and February 2020. Measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) was obtained in 14 patients.

Results

The median clinical and radiological follow-up periods were 46.6 months (range, 15.9–105.8) and 27.5 months (range, 15.4–105.8), respectively. Twenty-eight patients underwent multisession (4 fractions) GKRS. The median cumulative marginal dose was 20 Gy (range, 16–24). Two patients underwent single-session GKRS. Marginal doses were 15 Gy and 10.5 Gy in each patient. The volume of CVM decreased in 29 (97%) patients. Visual acuity was improved in 6 (20%) patients and was stable in 22 (73%) patients. Visual field defect and exophthalmos were improved in all patients. Serial investigation of OCT showed no statistically significant difference in pRNFL thickness after GKRS. Patients with normal average pRNFL thickness showed better visual recovery than patients with thin average pRNFL thickness.

Conclusions

GKRS is an effective and safe treatment option for orbital CVM. The pRNFL thickness before GKRS can be a prognostic indicator for visual recovery in orbital CVM after GKRS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Ares WJ, Flickinger JC, Lunsford LD (2019) Leksell radiosurgery for orbital, uveal, and choroidal tumors. Prog Neurol Surg 34:298–305

    PubMed  Google Scholar 

  2. Arnett ALH, Reynolds MM, Pulido JS, Parney IF, Laack NN (2017) Gamma Knife stereotactic radiosurgery for the treatment of primary and metastatic ocular malignancies. Stereotact Funct Neurosurg 95:363–368

    PubMed  Google Scholar 

  3. Bagheri A, Jafari R, Salour H, Aletaha M, Yazdani S, Baghi S (2018) A new surgical technique for excision of orbital cavernous hemangioma: a 15-year experience. Orbit 37:429–437

    PubMed  Google Scholar 

  4. Bekdemir S, Gunduz AK, Ersoz CC (2020) Orbital cavernous hemangioma presenting with a dome-shaped maculopathy-like appearance on swept-source optical tomography imaging. Case Rep Ophthalmol Med 2020:5354609

    PubMed  PubMed Central  Google Scholar 

  5. Budenz DL, Anderson DR, Varma R, Schuman J, Cantor L, Savell J, Greenfield DS, Patella VM, Quigley HA, Tielsch J (2007) Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology 114:1046–1052

    PubMed  PubMed Central  Google Scholar 

  6. Calandriello L, Grimaldi G, Petrone G, Rigante M, Petroni S, Riso M, Savino G (2017) Cavernous venous malformation (cavernous hemangioma) of the orbit: current concepts and a review of the literature. Surv Ophthalmol 62:393–403

    PubMed  Google Scholar 

  7. Chung KS, Chang WS, Chang JH, Lee SC, Chang JW, Park YG, Jung HH (2020) Gamma Knife radiosurgery for choroidal hemangioma: a single-institute series. World Neurosurg 133:e129–e134

    PubMed  Google Scholar 

  8. Colletti G, Biglioli F, Poli T, Dessy M, Cucurullo M, Petrillo M, Tombris S, Waner M, Sesenna E (2019) Vascular malformations of the orbit (lymphatic, venous, arteriovenous): diagnosis, management and results. J Craniomaxillofac Surg 47:726–740

    PubMed  Google Scholar 

  9. Danesh-Meyer HV, Papchenko T, Savino PJ, Law A, Evans J, Gamble GD (2008) In vivo retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after surgery for parachiasmal tumors. Invest Ophthalmol Vis Sci 49:1879–1885

    PubMed  Google Scholar 

  10. Dsouza S, Kandula P, Kamath G, Kamath M (2017) Clinical profile of unilateral proptosis in a tertiary care centre. J Ophthalmol 2017:8546458

    PubMed  PubMed Central  Google Scholar 

  11. Goh ASC, Kim YD, Woo KI, Lee JI (2013) Benign orbital apex tumors treated with multisession Gamma Knife radiosurgery. Ophthalmology 120:635–641

    PubMed  Google Scholar 

  12. Haas A, Pinter O, Papaefthymiou G, Weger M, Berghold A, Schrottner O, Mullner K, Pendl G, Langmann G (2002) Incidence of radiation retinopathy after high-dosage single-fraction Gamma Knife radiosurgery for choroidal melanoma. Ophthalmology 109:909–913

    PubMed  Google Scholar 

  13. Hamed-Azzam S, Verity DH, Rose GE (2018) Lateral canthotomy orbitotomy: a rapid approach to the orbit. Eye (Lond) 32:333–337

    CAS  Google Scholar 

  14. Iorga RE, Moraru A, Ozturk MR, Costin D (2018) The role of optical coherence tomography in optic neuropathies. Rom J Ophthalmol 62:3–14

    PubMed  PubMed Central  Google Scholar 

  15. Jayaram A, Cohen LM, Lissner GS, Karagianis AG (2017) A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations. Orbit 36:128–134

    PubMed  Google Scholar 

  16. Jeon C, Park KA, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Shin HJ, Kong DS (2019) Clinical efficacy of optical coherence tomography to predict the visual outcome after endoscopic endonasal surgery for suprasellar tumors. World Neurosurg 132:e722–e731

    PubMed  Google Scholar 

  17. Jo KI, Im YS, Kong DS, Seol HJ, Nam DH, Kim YD, Lee JI (2012) Multisession Gamma Knife surgery for benign orbital tumors. J Neurosurg 117(Suppl):102–107

    PubMed  Google Scholar 

  18. Johnson S, Niranjan A, Kano H, Lunsford LD (2019) Leksell radiosurgery for the 3 H tumors: hemangiomas, hemangioblastomas, and hemangiopericytomas. Prog Neurol Surg 34:223–231

    PubMed  Google Scholar 

  19. Jones B, Dale RG, Deehan C, Hopkins KI, Morgan DA (2001) The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol) 13:71–81

    CAS  Google Scholar 

  20. Jung S, Bosch A, Ott C, Kannenkeril D, Dienemann T, Harazny JM, Michelson G, Schmieder RE (2020) Retinal neurodegeneration in patients with end-stage renal disease assessed by spectral-domain optical coherence tomography. Sci Rep 10:5255

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Khan AA, Niranjan A, Kano H, Kondziolka D, Flickinger JC, Lunsford LD (2009) Stereotactic radiosurgery for cavernous sinus or orbital hemangiomas. Neurosurgery 65:914–918 discussion 918

    PubMed  Google Scholar 

  22. Khan SN, Sepahdari AR (2012) Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies. Saudi J Ophthalmol 26:373–383

    PubMed  PubMed Central  Google Scholar 

  23. Kim BS, Im YS, Woo KI, Kim YD, Lee JI (2015) Multisession Gamma Knife radiosurgery for orbital apex tumors. World Neurosurg 84:1005–1013

    PubMed  Google Scholar 

  24. Kim CY, Lee SY (2012) Orbital paraganglioma: Gamma Knife surgery as a therapeutic option. J Craniofac Surg 23:1127–1128

    PubMed  Google Scholar 

  25. Kim MS, Park K, Kim JH, Kim YD, Lee JI (2008) Gamma Knife radiosurgery for orbital tumors. Clin Neurol Neurosurg 110:1003–1007

    PubMed  Google Scholar 

  26. Kim YT, Kang SW, Lee JI (2011) Gamma Knife radiosurgery for choroidal hemangioma. Int J Radiat Oncol Biol Phys 81:1399–1404

    PubMed  Google Scholar 

  27. Liu D, Li Y, Zhang Y, Zhang Z, Song G, Xu D (2018) Volume-staged Gamma Knife radiosurgery for orbital venous malformations. J Neurosurg 129:26–30

    PubMed  Google Scholar 

  28. Liu X, Xu D, Zhang Y, Liu D, Song G (2010) Gamma Knife surgery in patients harboring orbital cavernous hemangiomas that were diagnosed on the basis of imaging findings. J Neurosurg 113(Suppl):39–43

    PubMed  Google Scholar 

  29. Loo JL, Tian J, Miller NR, Subramanian PS (2013) Use of optical coherence tomography in predicting post-treatment visual outcome in anterior visual pathway meningiomas. Br J Ophthalmol 97:1455–1458

    PubMed  Google Scholar 

  30. Maberley DA, Hollands H, Chuo J, Tam G, Konkal J, Roesch M, Veselinovic A, Witzigmann M, Bassett K (2006) The prevalence of low vision and blindness in Canada. Eye (Lond) 20:341–346

    CAS  Google Scholar 

  31. Milano MT, Grimm J, Soltys SG, Yorke E, Moiseenko V, Tome WA, Sahgal A, Xue J, Ma L, Solberg TD, Kirkpatrick JP, Constine LS, Flickinger JC, Marks LB, El Naqa I (2018) Single- and multi-fraction stereotactic radiosurgery dose tolerances of the optic pathways. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2018.01.053

  32. Millar WT, Hopewell JW, Paddick I, Lindquist C, Nordstron H, Lidberg P, Garding J (2015) The role of the concept of biologically effective dose (BED) in treatment planning in radiosurgery. Phys Med 31:627–633

    PubMed  Google Scholar 

  33. Modorati GM, Dagan R, Mikkelsen LH, Andreasen S, Ferlito A, Bandello F (2020) Gamma Knife radiosurgery for uveal melanoma: a retrospective review of clinical complications in a tertiary referral center. Ocul Oncol Pathol 6:115–122

    PubMed  Google Scholar 

  34. Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, Grosu AL, Lagerwaard FJ, Minniti G, Mirimanoff RO, Ricardi U, Short SC, Weber DC, Belka C (2016) ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 118:35–42

    PubMed  Google Scholar 

  35. Paddick I, Lippitz B (2006) A simple dose gradient measurement tool to complement the conformity index. J Neurosurg 105(Suppl):194–201

    PubMed  Google Scholar 

  36. Ratnayake GS, McNab AA, Dally MJ, Zajarski C, Senthi S, Ruben JD (2019) Fractionated stereotactic radiotherapy for cavernous venous malformations of the orbital apex. Ophthalmic Plast Reconstr Surg 35:322–325

    PubMed  Google Scholar 

  37. Scheuerle AF, Steiner HH, Kolling G, Kunze S, Aschoff A (2004) Treatment and long-term outcome of patients with orbital cavernomas. Am J Ophthalmol 138:237–244

    PubMed  Google Scholar 

  38. Schmidt P, Kempin R, Langner S, Beule A, Kindler S, Koppe T, Volzke H, Ittermann T, Jurgens C, Tost F (2019) Association of anthropometric markers with globe position: a population-based MRI study. PLoS One 14:e0211817

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Seibel I, Cordini D, Hager A, Tillner J, Riechardt AI, Heufelder J, Davids AM, Rehak M, Joussen AM (2016) Predictive risk factors for radiation retinopathy and optic neuropathy after proton beam therapy for uveal melanoma. Graefes Arch Clin Exp Ophthalmol 254:1787–1792

    CAS  PubMed  Google Scholar 

  40. Shchurova IN, Pronin IN, Mel’nikova-Pitskhelauri TV, Serova NK, Grigor'eva NN, Fadeeva LM, Shishkina LV (2018) Orbital hemangiomas: capabilities of modern neuroradiological diagnostics. Zh Vopr Neirokhir Im N N Burdenko 82:57–69

    CAS  PubMed  Google Scholar 

  41. Singh D, Pushker N, Bajaj MS, Saxena R, Sharma S, Ghose S (2012) Visual function alterations in orbital tumors and factors predicting visual outcome after surgery. Eye (Lond) 26:448–453

    CAS  Google Scholar 

  42. Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y (2013) Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics 33:1739–1758

    PubMed  Google Scholar 

  43. Tanaka A, Mihara F, Yoshiura T, Togao O, Kuwabara Y, Natori Y, Sasaki T, Honda H (2004) Differentiation of cavernous hemangioma from schwannoma of the orbit: a dynamic MRI study. AJR Am J Roentgenol 183:1799–1804

    PubMed  Google Scholar 

  44. Tata A, Cohen-Inbar O, Sheehan JP (2016) Treatment of orbital solitary fibrous tumour with Gamma Knife radiosurgery and systematic review of literature. BMJ Case Rep 2016. https://doi.org/10.1136/bcr-2016-217114

  45. Thompson TP, Lunsford LD, Flickinger JC (2000) Radiosurgery for hemangiomas of the cavernous sinus and orbit: technical case report. Neurosurgery 47:778–783

    CAS  PubMed  Google Scholar 

  46. Xu D, Liu D, Zhang Z, Zhang Y, Li Y, Liu X, Jia Q, Zheng L, Song G (2010) Gamma Knife surgery in the management of orbital tumors. J Neurosurg 113(Suppl):34–38

    PubMed  Google Scholar 

  47. Xu D, Liu D, Zhang Z, Zhang Y, Song G (2011) Gamma Knife radiosurgery for primary orbital varices: a preliminary report. Br J Ophthalmol 95:1264–1267

    PubMed  Google Scholar 

  48. Young SM, Kim KH, Kim YD, Lang SS, Park JW, Woo KI, Lee JI (2019) Orbital apex venous cavernous malformation with optic neuropathy: treatment with multisession Gamma Knife radiosurgery. Br J Ophthalmol 103:1453–1459

    PubMed  Google Scholar 

  49. Young SM, Kim YD, Lee JH, Woo KI (2018) Radiological analysis of orbital cavernous hemangiomas: a review and comparison between computed tomography and magnetic resonance imaging. J Craniofac Surg 29:712–716

    PubMed  Google Scholar 

  50. Zamber RW, Kinyoun JL (1992) Radiation retinopathy. West J Med 157:530–533

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank Hee Yae An, R.N., and Yong-Seok Im, PhD., of the Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, who assisted with data collection and technical support.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Won Jae Lee, Kyung-Rae Cho, Jung-Won Choi, Doo-Sik Kong, Ho Jun Seol, Do-Hyun Nam & Jung-Il Lee

  2. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Yoon-Duck Kim & Kyung In Woo

Authors
  1. Won Jae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung-Rae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung-Won Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Doo-Sik Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ho Jun Seol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Do-Hyun Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoon-Duck Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kyung In Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jung-Il Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung-Il Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Samsung Medical Center Institutional Review Board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Code availability

Not applicable.

Additional information

Comments

Won Jae Lee et al have investigated clinical and radiological outcome in 30 patients who underwent GKRS for orbital cavernous venous malformations. This unique series is demonstrating GKRS to be an effective and very safe alternative to resection surgery. Very interestingly the authors have used optical coherence tomography (OCT) in 14 patients in order to study the predictive value of peripapillary retinal nerve fiber layer (pRNFL) thickness. They found no post-radiosurgery change in pRNFL. More importantly they have shown that patients with normal average pRNFL thickness were demonstrating a better visual recovery. However, it is a retrospective heterogeneous series. All the patients were not treated using the same protocol (single versus hypofractionation) not all the patients were investigated with OCT. Their use of the linear quadratic formula and BED for single dose is nowadays not consensual. The absence of eye ball fixation during imaging and SRS is also a potential matter of debate.

Anyway, this is a very convincing paper which may affect, in the future the management of these patients.

Jean Marie Regis

Marseille, France

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presentation at a conference

None.

This article is part of the Topical Collection on Tumor - Other

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, W.J., Cho, KR., Choi, JW. et al. Stereotactic radiosurgery for orbital cavernous venous malformation: a single center’s experience for 15 years. Acta Neurochir 163, 357–364 (2021). https://doi.org/10.1007/s00701-020-04575-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04575-4

Keywords

Search

Navigation