Workup
Imaging Studies
CT scan detects an oval or round shaped, sharply marginated, homogenous lesion. Uptake of contrast medium by this tumefaction is highly variable and has limited diagnostic value. Computerized tomography should not be solely relied upon since it does not allow one to make a definitive diagnosis.
Ultrasound study can find a uniform high-echogenicity on A-scan. These reflections are secondary to the septae found within the lesion. Doppler flow study may reveal subdued blood flow within the angioma. [4]
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Histologic Findings
Histopathologic study finds engorged vascular channels, which are tightly knit and separated by fibrous septae. These channels can have diameters measuring 1 mm and are lined by a single layer of endothelial cells.
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Media Gallery
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Extirpation of an orbital cavernous hemangioma. Note en bloc removal and preservation of capsule. Courtesy of Robert Alan Goldberg, MD.
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MRI demonstrates enhancing mass in apex of left orbit. White arrow points to the superior portion of the optic nerve, showing its deviation. Mass was pressing on superotemporal optic nerve and displacing it inferomedially at apex. Patient had 6 months of progressive decreased vision and visual field loss. Courtesy of M. Duffy, MD, PhD.
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In A, final preoperative visual field of same patient as in Media file 2, demonstrating significant inferior altitudinal field loss; in B, postoperative visual field at approximately 3 weeks after orbital apex decompression and removal of mass; and in C, postoperative visual field at approximately 6 months.
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Intraoperative photo of same patient as in Media file 2. Neurosurgical service performed craniotomy and decompression of the superior orbital fissure and optic canal (yellow arrows) at request of ophthalmology service. Orbital surgery service then opened the periorbita over a bulge (double black arrows) between optic nerve and cranial nerves (single black arrow) and bluntly dissected out mass. Pathology confirmed mass as a cavernous hemangioma. Cranial nerves V and IV were adhered, and careful blunt separation was performed. Postoperatively, a small left hypertropia resolved over 6 weeks. Courtesy of M. Duffy, MD, PhD.
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