Cavernous Hemangioma Treatment & Management
- Author: Adam J Cohen, MD; Chief Editor: Hampton Roy, Sr, MD more...
Most cavernous angiomas require no intervention. If surgical extirpation is indicated, the approach to the orbit is dictated by tumor location within the orbit.
Most cavernous angiomas are found between the optic nerve and extraocular muscles within the intraconal space. A lateral orbitotomy, or a variant thereof, is a typical approach. Tumors within the medial aspect of the orbit are approached best through an upper eyelid or a transcaruncular-based medial orbitotomy. Additionally, an anterior orbitotomy via a lower eyelid transconjunctival approach can be used. This approach was used for removal of intraconal hemangiomas extending to the orbital apex.
See the images below.
After adequate exposure, a well-circumscribed, purple, encapsulated lesion is seen with distinct vessels on its surface. Gentle blunt dissection allows for en-bloc removal after all vessels have been identified and cauterized with bipolar cautery.
See the image below.
The cryoprobe allows for removal of well-circumscribed lesions, reducing the incidence of capsular rupture and bleeding, making it an ideal tool for hemangioma extirpation. A disadvantage of the cryoprobe is that adjacent orbital structures also may be frozen, as is the case with deep orbital tumors.
Use of the carbon dioxide laser or Nd:YAG laser is another modality for the surgeon faced with the task of tumor removal.
Gamma knife surgery has been used with success. Liu et al found gamma knife surgery to be an effective treatment in 23 patients with orbital cavernous hemangiomas.
If the cavernous hemangioma has an intracranial component or extends to facial structures outside the orbit, neurosurgical or otolaryngologic consultation should be sought.
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