A 44-year-old male with left eye proptosis since she was 4 years old.
She presented skin lesions like coffee with milk and cutaneous fibromas, being diagnosed with neurofibromatosis type 1 without family history of this condition.
Patient suffered progressive growth of left eye volume and intermittent retro-ocular pain in the last 10 years.
The vision of the right eye is 20/200 and that of the contralateral eye is normal.
1.
Both computed tomography (CT) and magnetic resonance imaging (MRI) reveal the absence of the greater wing of the sphenoid bone.
The orbita presents increased volume, with lower displacement of the orbital floor and lateral displacement of the lateral walls.
The orbital cavity was occupied by a cystic tumor suggestive of subarachnoid cyst of the frontal region of the temporal lobe, with displacement of the eyeball.
1.
We performed a surgical approach through frontotemporal skin incision and left orbitocraneal osteotomy.
The temporary removal of the supraorbital ring allowed us to give a view of the configuration of the upper part of the orbit.
We identified and drained the subarachnoid cyst and performed cystocystostomy.
Later, the periorbital tissue was separated from the upper frontal dura mater and from the temporal dura mater medially, and the lateral walls and the orbital floor were equally divided.
In this way, we perform reconstruction of the roof and posterior wall of the orbit by placing a titanium mesh with a profile of 0.85 mm high and dimensions of 5 x 4 cm, fixed orbital fixation with a fixed orbital rim 2.0.
Then, we dissected a 10 x 8 cm pericranium flap to cover the mesh, and fixed it at its base with absorbable suture (direct polyglycolic acid 3-0), thus avoiding contact.
1.
We continue with a preseptal transconjunctival approach through which we perform an osteotomy of the orbitus and raise the position equal to the contralateral one, making fixation with a wire.
We performed medial transnasal canthopexy using wire (diameter 0.016) and lateral canthopexy with non-absorbable suture (ny 2-0), fixing the periosteum for ocular replacement.
In the postoperative tomographic control we observed an adequate repositioning of the eyeball with reconstruction of the orbital cavity, adequately separating the cystic component of the temporal lobe.
1.
In the clinical follow-up 8 months after the intervention, the patient continues with right eye vision 20/200, left eye 200/200, without recurrence of exophthalmos and with symmetrical position of the eyeball not achieved a contralateral place.
