Name of Procedure: right orbital hematoma resection via combined medial and lateral orbitotomy + embolization for vascular tumor + decompression of orbital medial wall
Anesthesia Method: general anesthesia
1. The patient was in supine position, prepped and draped in the usual sterile manner.
2. The outer canthus of right eye was preserved. A horizontal incision in lateral skin was made (about 2cm in length). The subcutaneous tissue was separated, to the periosteum of orbital border. The periosteum was cut open with electrotome. The periosteum of lateral wall was cut open. The retrobulbar region was full of tumor tissue, purple in color, with superficial thin-walled capsule which was covered with blood vessels, with internal dark-red fluid, consistent with vascular tumor with hemorrhage and hematoma.
3. Via blunt dissection, the tumor capsule was separated from adhesion with surrounding tissue. The capsule was punctured and 8ml hematocele was drained. 0.5ml mixture of Glubran 2 seal and Lipiodol was injected (1: 2). Exploration indicated that the vascular tumor tissue in retro-bulbar deep orbit grossly hardened after effective embolization. Since the tumor was adhered to and encircled by the nerve and vessel in orbit apex, resection would cause massive hemorrhage and hemostasis couldn't be achieved so it would cause vision loss and other complications. Therefore, resection was not be performed.
4. After embolization, the orbital pressure increased, suggestive of new hemorrhage in the malformed vascular mass. The capsule of retro-bulbar malformed vascular mass was cut open, the fresh blood poured out and the orbital pressure was relieved. Tamponade was given using hemostatic sponge, the vessel was sutured and compression hemostasis was achieved.
5. To relieve exophthalmos and avoid postoperative high orbital pressure, partial bone of ethmoid lamina papyracea and inner lower corner region was resected to enlarge the orbital cavity.
6. There was no active hemorrhage or blood oozing. The exophthalmos was improved markedly. A drainage tube was placed in surgical region. The bone flaps were repositioned and the incision was closed layer by layer. The operation processed smoothly.