title: Unusual case of traumatic neuroma of the orbit.
abstract: Traumatic or amputation neuromas are neoformations developing after damage to a peripheral nerve. They are not proper tumors but rather a reactive process or a frustrated attempt of nerve regeneration. Traumatic neuromas are potentially found in every sensory peripheral nerve and often at the site of past surgical intervention, including orbital surgery. A 29-year-old Northern African migrant presented progressive exophthalmos and progressive loss of acuity in left eye, which had started about 6 months before after a cranio-facial trauma caused by a violent assault. MRI of the orbits showed a massive intra-orbital, intra-conical lesion, clearly compressing and dislocating the optic nerve and extending posteriorly to the orbital apex. Surgery was performed through lateral approach of Kroenlein and led to complete excision of the lesion. Histology revealed fibrotic, adipose and striated muscle tissues, a disordered, non-neoplastic overgrowth of small and large fascicles of nerves, inflammatory infiltrates, and fibrosis with sparse calcifications were diffusely observed in a background of fat, scar and striated muscle tissued. Patient was discharged on the fifth day in good health condition, without deficit of eye motion but without recovery of visual acuity. In conclusion, this case demonstrates that traumatic neuromas may arise in the orbit in patients with minor direct trauma to nerves and without previous surgical treatment.
authors.affiliation: a Department of Neurosurgery , Policlinico "Santa Maria alle Scotte," Siena , Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ulivieri
authors.affiliation: a Department of Neurosurgery , Policlinico "Santa Maria alle Scotte," Siena , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muscas
authors.affiliation: b Department of Human Pathology and Oncology , University of Siena , Siena , Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Miracco
authors.affiliation: a Department of Neurosurgery , Policlinico "Santa Maria alle Scotte," Siena , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oliveri
authors.affiliation: c Neuroimaging and Neurointerventional (NINT) Unit , Policlinico "Santa Maria alle Scotte," Siena , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Galluzzi
authors.affiliation: d Department of Medicine, Surgery and Neuroscience , University of Siena , Siena , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giorgio
mesh_terms: D000328:Adult; D001766:Blindness / Q000209:etiology; D005094:Exophthalmos / Q000209:etiology; D005151:Facial Injuries / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009463:Neuroma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D020221:Optic Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D019574:Optic Nerve Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D009915:Orbit / Q000293:injuries; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
keywords: Orbit; neuroma; neurosurgery