Cavernous hemangioma of the orbit: Case report and a review of the literature

Cryoprobe-Assisted Excision of Cavernous Hemangioma of the Orbit: A Clinical Case Report

This case report details the management of orbital cavernous hemangioma in a middle-aged female. The treatment involved a medial orbitotomy combined with an innovative application of a cryoprobe. This approach underscores the benefits of open orbitotomy, particularly when combined with cryoextraction. This combination provides improved control over bleeding and results in a substantial reduction in surgical time, offering valuable insights in the context of the contemporary trend towards endoscopic surgeries.

Imaging of the skull base and orbital tumors

The skull base and orbit have complicated anatomical structures where various tumors can occur. The tumor may present with neurological symptoms; however, its diagnosis is clinically difficult owing to accessibility issues. Therefore, diagnostic imaging is crucial in assessing tumors in the skull base and orbit and guiding subsequent management. Notably, some tumors have a predilection for a specific site of origin, and identifying the site of origin on imaging can help narrow the differential diagnosis. At the skull base, chordomas typically occur in the clivus, chondrosarcomas in the paramedian areas, paragangliomas in the jugular foramen, neurogenic tumors, and perineural spread in the neural foramen. Among orbital tumors, cavernous hemangiomas usually occur in the intraconal space, and pleomorphic adenomas and adenoid cystic carcinomas occur in the lacrimal glands. Some skull base and orbital tumors exhibit distinctive imaging features. Chordomas and chondrosarcomas of the skull base show high signal intensities on T2-weighted images, with chondrosarcomas often displaying cartilaginous calcifications. Paragangliomas are characterized by their hypervascular nature. In the orbit, cavernous hemangiomas and pleomorphic adenomas present unique dynamic patterns. Immunoglobulin G4-related disease forms lesions along the nerves. Identifying the tumor origin and its imaging characteristics can help narrow the differential diagnosis of skull base and orbital tumors.

Gamma knife radiosurgery for orbital cavernous hemangioma: a systematic review and single-arm meta-analysis

PURPOSE

Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH.

METHODS

In accordance with the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH. Studies reporting complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate for OCH following GKRS were included.

RESULTS

Six studies, out of 1856 search results, with 100 patients were included. Among them, only 5 minor complications were related to GKRS, including 3 with orbital pain and 2 with periorbital chemosis. Thus, the complication rate was 13% (95% CI, 7-25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI, 63-96%) and 71% (95% CI, 47-95%) respectively. Proptosis improved in 94% of cases (95% CI, 83-100%). The tumor reduction rate was 77% after GKRS (95% CI, 69-85%).

CONCLUSION

GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by an absence of a control group. Additional studies are needed to evaluate the relative efficacy of GKRS as compared with alternative surgical modalities for OCH.

Endoscopic Endonasal Approach to the Orbit: A Case Series and Clinical Experience Emphasizing the Advantages of the Ipsilateral Mononostril Technique

BACKGROUND

Lesions situated within the orbit pose significant challenges in management due to the confined space they occupy and their proximity to critical anatomical structures. The objective of our study is to assess the feasibility of the ipsilateral endoscopic endonasal approach for orbital cavernous hemangiomas and to comprehend the surgical anatomy of the orbital apex and inferomedial orbital structures.

METHODS

Thirteen patients (8 women, 5 men), with ages ranging from 25 to 54 years (mean 35.2 ± 8.3 years), with orbital cavernous hemangioma who underwent surgery via the ipsilateral mononostril endoscopic endonasal approach between August 2018 and August 2023 were retrospectively evaluated. Demographic characteristics, clinical data, radiographic images, and clinical outcomes of the patients were collected from digital medical records.

RESULTS

The left orbit was more commonly affected (9 left, 4 right). The average postoperative follow-up duration was 22.2 months (range: 6-50 months). Among the 13 cases of orbital cavernous hemangioma, 1 (7.7%) was located in the extraconal compartment, and 12 (92.3%) were situated in the intraconal compartment. Complete surgical resection of the tumor was successfully achieved in all patients.

CONCLUSIONS

Our study highlights the potential advantages of employing a purely ipsilateral mononostril endoscopic endonasal approach for orbital surgery, particularly for accessing the orbital apex and managing medial and inferomedial orbital lesions. This technique holds promise for reducing morbidity and enhancing outcomes, especially when combined with careful patient selection, preoperative planning, and advanced endoscopic skills.

Case report of cavernous haemangioma in the supraorbital region in the extraconal space: A rare location

Introduction

Cavernous haemangioma is the most common benign non-infiltrative neoplasm of the orbit. Most cavernous haemangiomas are intraconal and lateral in location.

Case report

We present a rare case of a cavernous haemangioma with an unusual location in the supraorbital region of the orbit, presenting with soft tissue swelling.

Discussion

Cavernous haemangiomas are the most common benign non-infiltrative neoplasms of the orbit and have a slowly progressive mass effect. A slowly progressive proptosis is the typical presenting symptom. Extraocular muscle impairment and impaired visual function are seen with large lesions and with lesions located at the orbital apex. Most cavernous haemangiomas are typically intraconal and lateral in location. Extraconal and medial locations are uncommon. Ultrasound, computed tomography and magnetic resonance imaging are useful imaging techniques for the evaluation of such tumours. Treatment of the tumour is surgical excision. Complete excision is generally accomplished as the tumour is well-encapsulated with relatively few feeding vessels.

Orbital hemangioma extirpation via a transnasal endoscopic surgical approach: A case report

INTRODUCTION

Orbital tumors are heterogeneous lesions originating from various structures in the eyeball, including the extraconal, conal, and intraconal spaces. One orbital tumor type is a vascular tumor, such as a hemangioma. Hemangiomas are most common in women aged 20-64 years. They are painless and slow-growing, leading to proptosis. The diagnosis can generally be established by clinical examination and computed tomography (CT) or magnetic resonance imaging scans. Orbital hemangioma management can involve regular observation of small and asymptomatic tumors or surgery for large symptomatic tumors.

PRESENTATION OF CASE

We report a 20-year-old Asian woman who presented with swelling on the medial side of her right eyelid that had increased over the last three months. A non-contrast head CT scan showed a mass in the right eye's medial wall. The patient underwent a joint operation with an ophthalmologist to remove the median orbital tumor by transnasal endoscopic orbital surgery. Anatomical pathology examination of the tumor tissue identified hemangiomas.

CONCLUSION

An endoscopic transnasal approach is a safe and effective way to access and manage an orbital tumor medial to the optic nerve. It is essential to have a multidisciplinary team with experience in endoscopic procedures. This patient had satisfactory results at their three-month postoperative follow-up. They reported no symptoms, and their CT scan did not show a relapsed mass in the right oculi region.