Clinico-Radiological Spectrum and Management of Orbital Schwannomas: A Tertiary Care Institute Study

Abstract

Purpose: The aim is to study clinical presentations, radiological features and outcome in histopathologically proven orbital schwannomas. Methods: A retrospective and longitudinal study of 16 patients between January 1999 and July 2011 was undertaken by reviewing the appropriate charts. Clinical and radiological data of all orbital schwannomas patients were analyzed. Results: Mean age was 28.18 years (range 8-40 years). Of 16 patients, 10 were males and 6 females. Duration of symptoms was chronic in 15(93%). Chief complaints were proptosis in 10(62.5%), eyelid swelling in 5(31%) and eyelid mass lesion in 2(12.5%). This included a rare case of cystic schwannoma with microphthalmos. Mass was extraconal in 11(69%). Radiological findings varied from solid to cystic, intraconal to extraconal, no enhancement to intense enhancement and presence of calcification. Thirteen (81%) were excised via anterior orbitotomy route while fronto-orbital craniotomy was done in 3(19%). Postoperatively, vision improved or remained stable in 15(94%) and worsened in one (6%). Final visual acuity of 6/6 was achieved in 11(69%), 6/9 in 2, 6/36 in one. Conclusions: Schwannomas may mimic a variety of mass lesions in the orbit because of variable clinical or imaging features and should be considered in the differential diagnosis of all well circumscribed orbital lesions.

Cystic Schwannoma Arising from Supraorbital Nerve Masquerading as a Dermoid: An Unusual Case

“…Sometimes orbital schwannoma can affect the eye by mechanical compression which can cause globe displacement, diplopia and proptosis [9][10][11]. Study conducted by Singh M., et al found that 69% of the orbital schwannoma were unilateral with preponderance for the right orbit [12], which correlates with our report. Garg R., et al and Dulani S., et al found that these orbital tumors were slow growing in nature and was not associated with any pain, globe displacement, ocular immobility or dimension of vision, which was also seen in our case report [4,6].…”

Atypical, Extremely Rapid Growth of Pediatric Orbital Neurilemmoma

“…6 Other cases of tumor expansion, both during pregnancy and otherwise, have been attributed to hemorrhage that may arise from a greater-than-usual tumor vasculature. 4,7 There always remains a concern that an area of malignant transformation was responsible for the rapid growth in our patient and that such a malignant area was not sampled: it is, however, reassuring that there has been no recurrence of this extremely fast-growing tumor over more than 4 years after removal.…”

Orbital Tumors—Clinical, Radiologic and Histopathologic Correlation

“…Most commonly, orbital schwannomas present with painless, non-pulsatile ocular proptosis, the displacement of the globe, or a palpable mass in the orbit. Lid swelling is also possible [ 78 , 79 ]. Due to the complexity of nerve fibers in the orbit, the specific nerve of origin can often not be identified.…”