SUPERIOR ORBITAL FISSURE SYNDROME CAUSED BY INTRAORBITAL SPREAD OF A CUTANEOUS SQUAMOUS-CELL CARCINOMA AND NOT DETECTED ON COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE-IMAGING
Rjw. Dekeizer et al., SUPERIOR ORBITAL FISSURE SYNDROME CAUSED BY INTRAORBITAL SPREAD OF A CUTANEOUS SQUAMOUS-CELL CARCINOMA AND NOT DETECTED ON COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE-IMAGING, Japanese Journal of Ophthalmology, 41(2), 1997, pp. 104-110
Intraneural and perineural spread of a squamous cell carcinoma of the
frontal region via the orbit to the cranial cavity is a rare cause of
a superior orbital fissure syndrome. This mode of tumor spread, for wh
ich a previously excised invasive malignant tumor is responsible, is r
arely reported. The absence of an intraorbital mass and the fact that
computed tomography (CT) and magnetic resonance imaging (MRI) are norm
al make the diagnosis extr remely difficult. We describe a 76-year-old
patient in whom both intraneural and perineural tumor growth deep int
o the orbit caused acute ocular motility disturbances, visual impairme
nt, and ocular dysfunction with subsequent cerebral and vascular dysfu
nction. Surgery, radiotherapy, and orbital exenteration did not preven
t spread of the tumor toward vital intracranial and intracerebral stru
ctures. Even the advanced diagnostic modalities of CT and MRI failed t
o reveal the cause of the pathologic process in our patient. In such a
case, one should look carefully for both intraneural and perineural t
umor invasion on previous histologic material and, if positive, treat
the patient with radical surgery on purely clinical grounds as early a
s possible. (C) 1997 Japanese Ophthalmological Society.