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M. Rosner, A. Priel, G. J. Ben Simon, N. Rosen; Our Experience With Anterior Approach and Cryoextraction for Surgery of Orbital Cavernous Hemangioma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5736.
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In the oculoplastic unit of the Goldschleger eye institute, transconjunctival or transcutaneous anterior orbitotomy using surgical microscope and cryoextraction is routinely employed for the removal of most orbital tumors. The purpose of this presentation is to summarize our experience with this cryo-assisted, minimally invasive, anterior approach used for extraction of orbital cavernous hemangiomas.
Retrospective, noncomparative, consecutive, interventional case series, of patients with orbital cavernous hemangioma operated on in the Goldschleger eye institute over the last 5 years. The medical records were reviewed and full data regarding the gender, age, location and size of the tumors, the surgical procedure and the result of short follow-up examination were retrieved.
During the last five years from October 2003 to September 2008, 73 patients underwent extraction of orbital tumors in the Goldschleger Eye Institute. In 24 of them (32.9%) the diagnosis was cavernous hemangioma. These patients included 12 males and 12 females, and their age at surgery was 47.3 + 10.3 years (mean + SD). Intraconal location was found in 20 (83.3%). The longest axis of the tumor was 10 to 40 mm (mean: 18.1 mm). Cryo-assisted extraction was employed in all operations. In all except one case the tumor was extracted using the minimally invasive anterior approach. The one case that underwent lateral orbitotomy had a very small, deeply located apical lesion. The operations with anterior approach lasted 57.9 + 15.0 minutes (mean + SD). In none of them there was need for transformation into lateral orbitotomy and there were no intra-operative complications. Post operative diplopia occurred in 3 patients. No deterioration of visual acuity was evident.
The anterior orbitotomy approach using surgical microscope and cryoprobe for extraction of orbital cavernous hemangioma is safe, relatively short and straightforward. This minimally invasive approach avoids, in most cases, the need for temporal or frontal bone flaps, and is suggest as the first choice for extraction of orbital cavernous hemangioma as well as other solid, well demarcated tumors. Large size of the tumor and location medial to the optic nerve, are not contra-indications for this surgical approach.
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