Orbital schwannoma management: a case report, literature review, and potential paradigm shift

Lopez, Jennifer; Hamill, Eric B.; Burnstine, Michael A.

doi:10.1080/01676830.2020.1858431

Cited by 6 publications

(7 citation statements)

References 151 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Accordingly, a substantial portion of the OCH tumors were found incidentally, whereas almost all the OSC patients were suffering from symptoms of tumor rapid growth. Furthermore, OCH is often found in middle age at 40–50 years, whereas OSC can present at any age ( 3 , 25 – 27 ). OSC may manifest heterogeneous on MRI just as a “geographic map.” Except for the above-mentioned two shape features, the other selected features, such as gldm_DependenceEntropy and glcm_MCC, all implied that OSC presented with heterogenous signal intensity.…”

Section: Discussionmentioning

confidence: 99%

MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma

et al. 2021

View full text Add to dashboard Cite

Aim: The purpose of this work was to develop and evaluate magnetic resonance imaging (MRI)-based radiomics for differentiation of orbital cavernous hemangioma (OCH) and orbital schwannoma (OSC).Methods: Fifty-eight patients (40 OCH and 18 OSC, confirmed pathohistologically) screened out from 216 consecutive patients who presented between 2015 and 2020 were divided into a training group (28 OCH and 12 OSC) and a validation group (12 OCH and 6 OSC). Radiomics features were extracted from T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). T-tests, the least absolute shrinkage and selection operator (LASSO), and principal components analysis (PCA) were used to select features for use in the classification models. A logistic regression (LR) model, support vector machine (SVM) model, decision tree (DT) model, and random forest (RF) model were constructed to differentiate OCH from OSC. The models were evaluated according to their accuracy and the area under the receiver operator characteristic (ROC) curve (AUC).Results: Six features from T1WI, five features from T2WI, and eight features from combined T1WI and T2WI were finally selected for building the classification models. The models using T2WI features showed superior performance on the validation data than those using T1WI features, especially the LR model and SVM model, which showed accuracy of 93% (85–100%) and 92%, respectively, The SVM model showed high accuracy of 93% (91–96%) on the combined feature group with an AUC of 98% (97–99%). The DT and RF models did not perform as well as the SVM model.Conclusion: Radiomics analysis using an SVM model achieved an accuracy of 93% for distinguishing OCH and OSC, which may be helpful for clinical diagnosis.

show abstract

Section: Discussionmentioning

confidence: 99%

MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma

et al. 2021

View full text Add to dashboard Cite

show abstract

“…We recently reported a case and extensively reviewed the English literature on orbital schwannomas, orbital neurilemomas, and extraorbital schwannomas. 2 Based on the literature reviewed and our case report, we recommend observation for asymptomatic or minimally symptomatic orbital schwannomas with minimal growth over an extended period of time, a similar contemporary management paradigm to facial nerve and vestibular schwannomas. For tumors that are rapidly growing or affecting key structures causing visual loss, diplopia, aesthetic disfigurement, or patient discomfort, more aggressive therapy may be necessary.…”

Section: To the Editormentioning

confidence: 92%

Re: “Orbital Schwannoma Management and Clinical Outcomes”

Burnstine

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

“…Schwannomas are peripheral nerve sheath tumors (PNST) found in cranial and spinal nerves throughout the body. Schwannomas of the orbit are rare, and there are less than 500 cases reported in the literature [ 16 ]. It is estimated that these tumors constitute only about 1% of orbital tumors [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that these tumors constitute only about 1% of orbital tumors [ 9 ]. They are typically benign, slow growing, and encapsulated tumors that occur without any predilection for sex or age [ 16 ]. The growth of these tumors has been associated to functional and/or aesthetic morbidity and malignant transformation seems to be exceedingly rare [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the surgical risks inherent to the complexity of the neurovascular structures of the orbit are not negligible [ 2 , 6 , 10 , 18 ] and warrant further investigation of the outcomes of conservative management. Recently, three separate reports have questioned the validity of an aggressive treatment strategy and advocate watchful waiting in selected cases [ 3 , 7 , 16 ]. In addition, increased use, availability, and sensitivity of diagnostic imaging makes incidental findings of orbital tumors more common, which also indicates a need for conservative approaches.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Conservative or surgical management of orbital schwannomas: a population-based case series

El-Hajj,

Singh,

Norin

et al. 2024

Acta Neurochir

View full text Add to dashboard Cite

Introduction Orbital schwannomas (OS) are rare occurrences with no more than 500 cases reported in the literature. The tumor’s potential to compromise the delicate neuro-ophthalmic structures within the orbit prompts surgical removal. Tumor removal is performed by ophthalmologists, often requiring a multidisciplinary surgical approach. The literature contains a very limited number of cases managed non-surgically. However, the inherent risks of orbital surgery warrant a comparison of the outcomes of conservative and surgical management strategies. Aims To review the national Swedish experience with the management of orbital schwannomas. Methods The study center is the primary Swedish referral center for the multidisciplinary management of orbital tumors, including schwannomas. During the period of 2005 to 2021, 16 patients with an OS diagnosis were managed at the center. Results Four patients initially underwent surgery where gross total resection (GTR) was achieved in three (75%) and subtotal resection (STR) in one (25%) case. The remaining 12 patients, who had a low risk of neuro-ophthalmic impairment, were managed conservatively with radiological and clinical examinations at regular intervals. After an average follow-up of 17 months, surgery was performed in three of these cases (25%). No recurrences or tumor growths were detected on radiological follow-ups (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n=9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was detected in one patient after 17 months. Conclusion There were no differences in long-term outcome between patients who had been managed with early surgery and those operated later after an initially conservative management. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, conservative management may successfully be adopted in cases with mild symptoms, no signs of compressive optic neuropathy and low risk of neuro-ophthalmic impairment. Conversion to surgical management is indicated upon clinical deterioration or tumor growth. Based on the findings of this study a decision tree for the management of orbital schwannomas is suggested.

show abstract

Orbital schwannoma management: a case report, literature review, and potential paradigm shift

Cited by 6 publications

References 151 publications

MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma

MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma

Re: “Orbital Schwannoma Management and Clinical Outcomes”

Conservative or surgical management of orbital schwannomas: a population-based case series

Contact Info

Product

Resources

About