Endoscopic resection of orbital hemangiomas

Background Cavernous hemangiomas are the most common orbital tumors in adults. Traditional orbitotomy approaches to resect these intraconal lesions are associated with patient morbidity due to difficulties with visualization and access in the region of the orbital apex. Methods In this retrospective chart review and case series, the records of 5 patients who underwent endoscopic resection of orbital hemangiomas by the senior authors (A.F. and R.M.) between 2007 and 2011 were reviewed. Patient demographics, preoperative, and postoperative variables were assessed. Results All tumors were located in the medial orbital apex. Mean tumor size was 1.7 cm in maximum dimension (range, 1.0-2.7 cm). Proptosis and/or optic neuropathy were present in all cases. Surgeries were performed through an entirely endoscopic transnasal approach. One patient underwent subtotal tumor resection. Proptosis improved by a mean +/- standard deviation of 1.75 +/- 0.87 mm. The average improvement in visual acuity was 1.8 lines on a Snellen chart (range, 1-4 lines). There were no long-term adverse sequelae. Conclusion Endoscopic techniques for the treatment of patients with hemangiomas in the posterior medial orbit appear to offer the advantage of enhanced surgical access with reduced patient morbidity compared to conventional orbitotomy approaches.