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case_images: Photos of ophthalmologic examination before treatment (A) Left eyelid ptosis (B) Left eyeball fixed in position, with limited movement in all directions.
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case_images: Ophthalmic examination is illustrated in Figures 1.
case_images: MRI Imaging Before Treatment (A) T1 FLAIR sequence of a brain MRI taken on February 20, 2024, with the arrow indicating a mass in the superior orbital fissure (1.0 x 0.8x0.9 cm, left-right x anterior-posterior x superior-inferior (B). (C) Contrast-enhanced brain MRI images showing the mass. (D) T2 Propeller sequence. (E) Clearer image of the left superior orbital fissure mass from the T1 FSE sequence of an orbital MRI taken on February 21, 2024.
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case_images: During this process, we identified a small abnormal signal in the left superior orbital fissure (Figures 2A-D). Repeated imaging provided clearer visualization of the lesion (Figure 2E), showing abnormal signals in the left orbital apex and the anterior edge of the left cavernous sinus, consistent with metastasis.
case_images: Target delineation diagram GTV2 as the mass in the superior orbital fissure, with a 3mm expansion to PGTV (excluding the optic nerve).
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case_images: GTV target areas. GTV1 and GTV2 were expanded by 3 mm to create PGTV1 and PGTV2, with no expansion at the optic nerve (Figure 3).
case_images: Photographs of the ophthalmologic examination taken after the completion of radiation therapy (A). The left eyelid has been elevated (B) The left eyeball moves freely in all directions (right, left, up, down).
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case_images: After radiation therapy, the left eyelid ptosis was alleviated, and her visual field and eye movement improved significantly (Figure 4).
case_images: MRI Imaging After Radiotherapy T1 FSE sequence of the orbital MRI (April 16, 2024), indicating a significant reduction in the size of the left superior orbital fissure mass (0.5 x 0.5 cm, left-right x anterior-posterior).
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case_images: Follow-up MRI on April 16, 2024, demonstrated significant reduction in the metastasis (Figure 5).