Atlas of Orbital Imaging

710 Pages·2021·58.336 MB·English

by  Guy Ben Simon (editor), Gahl Greenberg (editor), Daphna Landau Prat (editor)

Guy Ben Simon
Gahl Greenberg
Daphna Landau Prat
Editors
Atlas of
Orbital Imaging
Atlas of Orbital Imaging
(cid:129) (cid:129)
Guy Ben Simon Gahl Greenberg
Daphna Landau Prat
Editors
Atlas of Orbital Imaging
With1275Figuresand5Tables
Editors
GuyBenSimon GahlGreenberg
OphthalmicPlasticandLacrimal DepartmentofDiagnosticImaging
SurgeryInstitute ShebaMedicalCenter
DepartmentofOphthalmology TelHashomer,Israel
TheGoldschlegerEyeInstitute
ShebaMedicalCenter
TelHashomer,Israel
DaphnaLandauPrat
OphthalmicPlasticandLacrimal
SurgeryInstitute
DepartmentofOphthalmology
TheGoldschlegerEyeInstitute
ShebaMedicalCenter
TelHashomer,Israel
ISBN978-3-030-62425-5 ISBN978-3-030-62426-2(eBook)
ISBN978-3-030-62427-9(printandelectronicbundle)
https://doi.org/10.1007/978-3-030-62426-2
©SpringerNatureSwitzerlandAG2022
Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthematerialis
concerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,broadcasting,reproduction
onmicrofilmsorinanyotherphysicalway,andtransmissionorinformationstorageandretrieval,electronicadaptation,
computersoftware,orbysimilarordissimilarmethodologynowknownorhereafterdeveloped.
Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublicationdoesnot
imply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevantprotectivelawsand
regulationsandthereforefreeforgeneraluse.
Thepublisher,theauthors,andtheeditorsaresafetoassumethattheadviceandinformationinthisbookarebelievedto
betrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsortheeditorsgiveawarranty,
expressedorimplied,withrespecttothematerialcontainedhereinorforanyerrorsoromissionsthatmayhavebeen
made.Thepublisherremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG.
Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland
Foreword 1
InspiredperhapsbymymentorJackRootman,Ihavebeenstudyingart.More,Iammakingmy
fellowstakedrawingclassesduringtheirtraining.Thedisciplineoflearningtodrawisallabout
increasingone’sskillinobservation.Andcarefulobservationistheheartoflearningtointerpret
orbitalimaging.
Asmuchaslookingataphotoofsomebreathtakingvista,orthemesmerizingphotomicro-
graphicpatternsofsomewonderofnature,Ivieworbitalimageswithcertainsenseofartistic
awe.Nature’sartisrevealedintheintricateanatomicpatterns,fascinatingcontourchangesthat
occurwithorbitalpathology,andnuancesofshapeandshadingthatarecreatedwithdifferent
imagingtechniques.
In this atlas, Professor Ben Simon, Drs. Greenberg, and Landau Prat have put together a
masterfulcollectionofimagesthatwillprovideanidealtoolforboththebeginningstudentand
theexperiencedpractitioner,toincreasetheirskillsofcarefulobservationandpatternrecogni-
tion. The more one looks at orbital images, the more one sees. I hope that the readers of this
atlascanappreciatetheamountofdedicationandeffortthattheeditorsandauthorshaveapplied
toproducethisoutstandingproduct.Iamoptimisticthatitwillimproveourabilitytooptimally
understandorbitaldiseaseandhelpourpatients.Andperhapsthereaderswill,aswell,bebetter
abletoappreciatetheintrinsicartisticbeautyoforbitalimaging.
Sincerely,
RobertAlanGoldberg,M.D.F.A.C.S.
KarenandFrankDabbyEndowedChairinOphthalmology
Chief,OrbitalandOphthalmicPlasticSurgery
SteinEye,DavidGeffenSchoolofMedicineatUCLA
v
Foreword 2
Orbitaldiseaseisuncommon,and,inarelativelysmallpartofthebody,thereisaverybroad
range of pathologies that can occur. This makes the diagnosis and management of orbital
disease challenging. Improvements in imaging over a number of decades have helped the
clinician enormously in establishing a diagnosis or a short list of differential diagnoses.
However, even with this additional information, experience in the interpretation of orbital
images is important, and correlating these images with the clinical presentation is vital in
ordertooptimallymanageeachpatientwithorbitaldisease.
This atlas fills an important niche by comprehensively documenting the appearances on
orbital imaging (largely computerized tomography (CT) and magnetic resonance imaging
(MRI)) of the broad range of orbital pathologies encountered in clinical practice. Drs Ben
Simon and Landau Prat have assembled a large international group of experienced orbital
specialists to author these chapters. The chapters and their numerous images have been
carefully selected, edited, and described with the aid of specialist radiologist Dr Gahl
Greenberg. The atlas should therefore provide invaluable information to those clinicians
managingpatientswithorbitaldisease,especiallyasthemajorityofsuchpatientswillbefirst
seenbydoctorswithlimitedexperienceinmanagingthebroadrangeofdiseasesaffectingthe
orbit.
This atlas will be a useful reference tool for all those clinicians managing patients with
orbitaldiseaseformanyyearstocome.DrsBenSimon,Greenberg,andLandauPratshouldbe
congratulatedforputtingtogethersuchausefulresource.
AlanA.Mcnab
AssociateProfessor
Consultant,OrbitalPlasticandLacrimalClinic
RoyalVictorianEyeandEarHospital
Melbourne,Australia
vii
Foreword 3
Thefoundationforthemanagementoforbitaldisordersrequiresamultidisciplinaryapproach.
Inaddition,theapproachisbasedonknowledgeoftheanatomicalterritoryoftheorbitaswell
as the diversity of the complex tissues within and surrounding it. Indeed, the orbit is also
affected by many systemic and neurological disorders as well. Clinical practice includes
structural lesions, inflammations, vascular anomalies, benign and malignant neoplasms, both
regional and metastatic, as well as lymphoproliferative disorders. In addition, an orbital
specialist has to interact with colleagues in many related disciplines and collate the clinical
observations,imaging,andpathologytoarriveatadiagnosisandtreatmentplaninthecontext
ofevolvingknowledgeandtechniques.
Theauthorsofthisbookhavefocusedontheimagingoforbitaldisordersderivedfromtheir
own cases and from outstanding institutions that focus on orbital disorders throughout the
world. The many cases are critically organized with contemporary imaging technology and
coverawiderangeofdisorders.
Iampleasedtobe part ofthispublication along with mycolleague, Mr.Bruce Stewart, to
provide our anatomical drawings of the orbit as a foundation for evaluation of disorders
requiring surgery. These images define the territory within and surrounding the orbit. When
paired with modern imaging, they will be useful for planning diagnostic, interventional, and
newsurgicalapproaches.
JackRootmanMDFRCSC
ProfessorEmeritus
OphthalmologyandVisionScience
PathologyandLaboratory
UniversityofBritishColumbia
VancouverCanada
ix
Preface
Every journey begins with a dream. Ours was clear, figuring out how to decipher orbital
imaging.Throughouttheyearsasorbitalsurgeons,everycasehasbroughtusalittlecloserto
this goal. Yet, the more you learn, the more you realize that there is an endless amount of
knowledgetoacquire.Asissowellputbyourmentors,orbitalimagingismoreartthanscience.
Wehavebeenfortunatetoknowallthesegreatteachers–worldexpertsinoculoplasticand
orbital surgery. Not only have they set a path for excellence in patients care, but also their
kindnessandgenerosityhavebeenirreproachable.Suchanatlascouldneverstandalonebased
on the work of one person. It is a collaborative effort of many. We cannot fully express our
gratitudetoallauthorswhohavemadeatremendouseffortinestablishingguidelinestoorbital
imaging,usingtheirpersonalexperience,know-how,andsharingtheirknowledge.
We have the honor and privilege to include Jack Rootman’s and Bruce Stewart’s anatomy
illustrations which have become inalienable assets for the ophthalmic literature. This is
somewhat symbolic as they started off with the anatomy atlas and have now merged into the
imagingatlas,constitutingasinglecontinuuminoculoplasticdatabase.Anirreplaceabletoolin
theunderstandingandteachingthiswonderfulworldoforbitalsurgery.
TheAtlasofOrbitalImagingisajointventureofophthalmologists,oculoplasticsurgeons,
anatomists,andneuroradiologists,facingtheeverlastingchallengeofcombiningtheirclinical
andimaginginterpretationskills.Itisaknownfactthatimaginghascapturedapivotalrolein
both surgical planning and medical management of our patients, necessitating close and
efficient collaborations between physicians, either through daily communications, timely
consultationsaswellasstructuredtumorboardsandintheformofmultidisciplinarymeetings.
We hope that the orbital imaging atlas will bring us a small step toward diagnosis and
enhancedpatientcare.
TelHashomer,Israel GuyBenSimon
October2021 GahlGreenberg
DaphnaLandauPrat
xi
Contents
PartI OrbitalAnatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 BonesoftheOrbit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
2 VascularAnatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
DanielB.Rootman,BruceStewart,andJackRootman
3 OcularAdnexa,SoftTissue,andExtraocularMuscles. . . . . . . . . . . . . . 33
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
4 ParanasalSinuses. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 47
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
5 OrbitalFissures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
6 OrbitalFissures:InferiorOrbitalFissure. . . . . . . . . . . . . . . . . . . . . . . . 69
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
7 OrbitalFissures:PterygopalatineFossa. . . . . . . . . . . . . . . . . . . . . . . . . 75
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
8 OrbitalFissures:InfratemporalFossa. . . . . . . . . . . . . . . . . . . . . . . . . . 79
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
9 CavernousSinus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
xiii
xiv Contents
10 Meckel’sCave. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
JackRootman,DanielB.Rootman,BruceStewart,StefaniaB.Diniz,
KelseyA.Roelofs,LizaM.Cohen,ClaireS.Smith,AyeletEran,
BenKaplan,andAssafMarom
PartII OrbitalImagingModalities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
11 OrbitalCT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
DeniseS.Kim,RemyR.Lobo,andAlonKahana
12 OrbitalMRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
ArnaldoMayerandGahlGreenberg
13 OrbitalCTA/CTV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
DeniseS.Kim,RemyR.Lobo,andAlonKahana
14 OrbitalMRA/MRV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
DeniseS.Kim,RemyR.Lobo,andAlonKahana
15 IntraoperativeDynamicImaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
DeniseS.Kim,RemyR.Lobo,NeerajChaudhary,andAlonKahana
16 UltrasoundofOrbitTumorsandTumorlikeLesions. . . . . . . . . . . . . . . 127
BernadeteAyresandAlonKahana
17 OrbitalUltrasoundwithDoppler. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
StefaniaB.DinizandRobertA.Goldberg
18 OrbitalPositronEmissionTomography/ComputedTomography
(PET/CT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
J.MatthewDebnamandBitaEsmaeli
19 OrbitalImagingPearls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
GahlGreenberg,DaphnaLandauPrat,andGuyBenSimon
PartIII CongenitalMalformations/Anomalies. . . . . . . . . . . . . . . . . . . . . . 189
20 CraniofacialDystosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
WilliamR.Katowitz
21 Neurofibromatosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
WilliamR.Katowitz
22 AnophthalmiaandMicrophthalmia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
WilliamR.Katowitz
23 CysticLesionsoftheOrbit:DermoidandEpidermoidCysts. . . . . . . . . 215
WilliamR.Katowitz
24 CysticLesionsoftheOrbit:Teratomas. . . . . . . . . . . . . . . . . . . . . . . . . 221
WilliamR.Katowitz
25 OtherCysticLesionsoftheOrbit:Encephalocele. . . . .. . . . . .. . . . . .. 225
WilliamR.Katowitz
26 CongenitalLacrimalPathologies:Dacryocystocele. . . . . . . . . . . . . . . . . 233
WilliamR.Katowitz
27 PediatricOrbitalVascularTumors:InfantileHemangioma. . . . . . . . . . 239
WilliamR.Katowitz