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Pierre-Antoine Aymard, Blandine Langlois, Pierre-Vincent Jacomet, Serge Morax, Olivier Galatoire; Therapeutical Management of Orbital Cavernous Hemangioma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1264.
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The aim of this study was to assess when surgical treatment was required for orbital cavernomas, and to determine clinical and functional outcomes of their 3 main approaches in ophthalmology: transconjunctival, anterior transcutaneous and lateral orbitotomy.
The records of all patients managed for cavernoma from 2002 to 2011 at Fondation Ophtalmologique Adolphe de Rothschild (Paris, France) were retrospectively reviewed.
Forty patients have been diagnosed for orbital cavernoma between 2002 and 2011. Fifty-eight percent were women, mean age was 51, 80% of the tumors were intraconal. Among those patients, 34 underwent surgical removal, 4 had periodic observation, and 2 were scheduled for surgery. Main surgical treatment indications were: optic nerve compression (24 patients), proptosis (22 patients) and diplopia (3 patients). Transconjunctival approach was used for 14 patients, anterior transcutaneous approach for 14 patients, and Kronlein approach (lateral orbitotomy) for 4. Four patients had en bloc resection of intrapalpebral cavernomas. Visual acuity improved in 8 patients, remained stable in 20 patients, and worsened in 1 patient who underwent transcutaneous anterior approach. Data was missing in 5 patients. Transient ocular movement impairment occurred in 6 patients (4 with transcutaneous anterior approach, 2 with transconjunctival approach), 2 patients had transient partial 3rd nerve palsy (1 with lateral orbitotomy approach and 1 with transconjunctival approach), 1 patient with lateral orbitotomy approach had complete ptosis with diplopia, and 1 patient with transcutaneous anterior approach had mydriasis.
Surgical removal of orbital cavernoma is required in case of optic nerve compression, diplopia or severe proptosis. Transconjunctival approach is a safe technique which can lead to complete resection of the tumor in most of the cases. Periodic observation with visual field and imagery is recommended for asymptomatic tumors.
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