Preoperative transarterial embolization of a recurrent orbital solitary fibrous tumor with significant hypervascularity: a case report

Abstract

Background Orbital solitary fibrous tumors (SFTs) are rare neoplasms. Recurrent, hypervascular, malignant variations of orbital SFTs have recently been noted and can present a surgical challenge. Case presentation We describe a case of a 53-year-old Chinese woman with a history of a resected orbital SFT. She presented with proptosis, limited eyeball movement, and visual loss in the right eye, suggestive of a recurrent SFT. Ocular examination with multimodal imaging revealed a large, nonpulsatile, noncompressible, hypervascular mass behind the eyeball. The patient underwent preoperative transarterial embolization of the main blood supply to the tumor in order to control intraoperative blood loss, followed by ocular enucleation to optimize exposure and enable complete resection of the tumor. Embolization of the right ophthalmic artery and the distal branch of the right internal maxillary artery caused an immediate, substantial reduction of vascular flow, which allowed us to enucleate the eyeball and resect the tumor with minimal blood loss and no complications. Conclusions Our case is so far the first Chinese case of successful preoperative embolization of the main blood supply to a large, recurrent, hypervascular orbital SFT. This case also described a different surgical approach to achieve total removal of an orbital SFT without osteotomy.

Giant cell-rich solitary fibrous tumour of the lacrimal gland with prominent angiomatoid cystic changes and an underlying NAB2ex3-STAT6ex18 fusion

“…Complete surgical removal of orbital SFT is the mainstay of treatment, sometimes preceded by preoperative embolisation in order to reduce the risk of intraoperative bleeding as recommended by several papers 25 26. Angiography may be used preoperatively to assess the tumour vascularity and to better plan for the surgery.…”

Preoperative Endovascular Embolization of Orbital Solitary Fibrous Tumor With 500-700 Micron Tris-Acryl Gelatin Microspheres

“…12 Recently, two cases of SFT in which Onyx was used by intraoperative intratumoral injection or via preoperative transophthalmic arterial route were reported. 13,14 The tumor was removed after piecemeal resection in the first case and after enucleation in the other. 13,14 Endovascular tumor embolization with particulate material has been previously reported in only one case of SFT.…”

“…13,14 The tumor was removed after piecemeal resection in the first case and after enucleation in the other. 13,14 Endovascular tumor embolization with particulate material has been previously reported in only one case of SFT. 15 In this case, an extraconal SFT in the superoanterior-mid orbit was embolized with 150-300 μm TAGM injected through the distal ophthalmic artery.…”

“…In a recent case, embolization of the ophthalmic artery with Onyx resulted in sudden, extreme orbital pain, severe conjunctival congestion, and oculocardiac bradycardia requiring immediate treatment, as well as permanent vision loss. 14 Intercarotid anastomoses, common arteries that supply both the tumor and normal structures, the caliber of feeding vessels, and potential reflux of embolic agent into the parent vessel are all factors that need to be considered before a decision to embolize. 7,16 TAGM are available in six different size ranges (40-120 μm to 900-1200 μm).…”

“…8 While smaller particles are able to penetrate more distally into tumor capillary beds, they can also enter the extratumoral circulation through collateral anastomoses. 14 Small particles (>300 μm) may cause more frequent complications in intracranial meningiomas. 17 In the present case, a large orbital SFT was safely embolized with 500-700 μm TAGM and could be completely surgically excised.…”