J Korean Neurosurg Soc.  2012 Feb;51(2):113-116. 10.3340/jkns.2012.51.2.113.

Aneurysmal Bone Cyst of the Orbit : A Case Report with Literature Review

• Yu JW
• Kim KU
• Kim SJ
• Choi S

• KMID: 1441422
• DOI: http://doi.org/10.3340/jkns.2012.51.2.113

Abstract

Aneurysmal bone cyst (ABC) is benign vascular lesion destructing the cortical bone by the expansion of the vascular channel in the diploic space that usually involve long bone and spine. Orbital ABC is rare and the clinical symptoms deteriorate rapidly after initial slow-progression period for a few months. A 12-year-old female patient visited ophthalmologist due to proptosis and upward gaze limitation of the right eye, and orbital mass was noted in the upper part of right eye on orbital MRI. Five months later, exophthalmos was worsened rapidly with other features of ophthalmoplegia. Orbital mass was enlarged on MRI with intracranial extension. Surgery was done through frontal craniotomy and intracranial portion of the tumor was removed. Destructed orbital roof and mass in the orbit was also removed, and surrounding bone which was suspected to have lesion was resected as much as possible. Histopathological diagnosis was aneurysmal bone cyst. Postoperative course was satisfactory and the patient's eye symptoms improved. Authors report a rare case of orbital ABC with review of the literature. Exact diagnosis by imaging studies is important and it is recommended to perform surgical resection before rapid-progressing period and to resect the mass completely to prevent recurrence.

Keyword

Aneurysmal bone cyst; Orbit; Craniotomy

MeSH Terms

Aneurysm
Bone Cysts
Child
Craniotomy
Exophthalmos
Eye
Female
Humans
Ophthalmoplegia
Orbit
Recurrence
Spine

Figure

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  Fig. 1 Initial Orbit magnetic resonance images. Inhomogenously-enhancing mass is noted in the right superior orbital area, compressing eyeball. T1-weighted image axial (A) and coronal images (B).

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  Fig. 2 Marked exophthalmos of right eye is noted 5 months after the initial diagnosis.

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  Fig. 3 Marked osteolytic changes are noted in orbital roof on plain film (A), CT (B). Brain MRI (enhanced) shows inferior and superior extension of the large multi-lobulated enhanced mass within homogenous fluid level in right orbit upper portion and intracranial portion compressing the frontal lobe and eyeball (C and D).

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  Fig. 4 Histopathological examinatin shows hemorrhagic cystic spaces and connective tissue with fibroblasts, osteoclast-type giant cells and woven bone was seen (H&E, ×100).

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  Fig. 5 Supraorbital mass is not noted on MRI taken 7 months after the operation. T1-enhanced axial (A) and coronal (B) view.

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  Fig. 6 Downward eyeball deviation is present and limitation of medial and upward gaze is noted at 13 months after operation.

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