Orbital Cavernomas Research Articles

Re: Pupil Abnormalities in Orbital Cavernomas: The Pupil Matters Both Preoperatively and Postoperatively.

Re: Pupil Abnormalities in Orbital Cavernomas: The Pupil Matters Both Preoperatively and Postoperatively.

Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients

The aim of this study is to assess the efficacy and safety of surgical treatment of orbital cavernomas in terms of clinical and functional results. Twenty consecutive patients underwent surgical removal of a unilateral orbital cavernoma between 1999 and 2009. Indications for surgical treatment were: visual impairment, diplopia due to ocular movement impairment, progressive and disfiguring unilateral proptosis, severe retroorbital pain clearly related to the orbital cavernoma. We used a topographic classification of the lesions within the orbit. The orbit has been divided into an anterior and a posterior compartment on the axial plane and into three sectors on the coronal plane. The proptosis was quantified on MRI scans. The location of the cavernoma determined the choice of the surgical approach. We performed eight lateral orbitotomies and 12 fronto-orbito-zygomatic approaches. All the tumors were completely removed as assessed at follow-up MRI. We did not record any intraoperative or major postoperative complication requiring a reoperation. The postoperative visual acuity improved in four of five patients with visual impairment, it worsened in the other case. Proptosis improved in all the patients. Diplopia improved in four patients, and did not recover in another case. Surgical treatment of symptomatic orbital cavernomas is safe and effective. Tumor location dictates the choice of surgical approach. Visual function and cosmetic result are the main parameters to evaluate the clinical outcome. Surgical approach and dissection technique are crucial in determining the visual outcome.

Analysis of clinically suspected orbital cavernomas

BackgroundOrbital cavernomas are low-flow vascular malformations that are the most common benign neoplasms of the orbit in adults, typically becoming symptomatic in the middle age.MethodsThe medical records of six patients...

Treatment and long-term outcome of patients with orbital cavernomas

Purpose To evaluate the long-term prognosis of visual function in patients with orbital cavernomas after conservative and surgical treatment. Design Interventional case series. Methods The authors describe the outcome of 20 patients with cavernous hemangiomas of the orbit treated in their departments between 1988 and 2003. This prospective study included five cases followed by clinical and radiologic observation and 15 cases of symptomatic tumors that were completely removed by means of a frontotemporal or by means of a transconjunctival approach. The clinical characteristics of orbital cavernomas were analyzed together with their appropriate treatment. Furthermore, the authors present the unusual case of a patient suffering from progressive visual deterioration from a cerebral cavernoma compressing the optic nerve. Results The follow-up period was between 3 and 10 years. All orbital cavernomas in the group of conservatively managed patients remained stable. The transconjunctival excision of a medially located lesion was uncomplicated. The frontotemporal approach was chosen for large tumors situated in the proximity of the orbital apex and was associated with a higher number of complications. A good overall outcome of visual function and patient satisfaction was achieved in 11 of 14 cases operated on by craniotomy. Conclusion The combination of clinical signs and magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of orbital cavernomas. In the presence of visual deterioration clearly attributable to the tumor we recommend immediate surgery, while lesions producing solely exophthalmos can safely be followed by observation. The transcranial approach offers excellent exposure and a rewarding cosmetic result and may be considered for large lesions superior and medial to the optic nerve, especially if they involve the orbital apex.

Surgical treatment of orbital cavernomas

Background There are numerous descriptions for the operative techniques applied in orbital lesions. We present a systematic overview of the surgical approaches, as determined by the location and extension of orbital cavernomas. Methods In our study, 37 patients (12 m, 25 f, aged 21–74 years, mean 51.22 years) underwent surgical removal of their orbital cavernoma at our clinic between 1988 and 2002. Results In ten cases the cavernoma was located in the lateral part of the intraconal space and a lateral orbitotomy was performed. Nine cavernomas were located more inferiorly and a transconjunctival approach was used. Seven cavernomas involving the optic canal, orbital apex and superior orbital fissure were operated on via an ipsilateral intradural approach. Four cavernomas of the superior orbital fissure or of the laterobasal intraconal space were approached extradurally. In one patient, a combined extra- intradural pterional operation was performed. Four patients with a lesion located medially in the posterior intraconal space were operated on via a contralateral pterional approach. One superior, medial, intraconal cavernoma was approached supraorbitally. In one cavernoma with direct contact to the sinus a transantral approach was used. The postoperative visual acuity improved in 14 of 19 cases with visual impairment, but in none with primary visual loss. Proptosis resolved completely in 21 of 27 patients. Ocular motility recovered in four of six patients, two patients with involvement of the superior orbital fissure presented with new oculomotor palsy postoperatively. Conclusions The location of the cavernoma determines the recommended surgical approach. Because of their tendency to lead to irreversible loss of visual acuity due to the mass effect, we favor early surgery after the onset of symptoms.

Orbital and cerebral cavernomas: comparison of clinical, neuroimaging, and neuropathological features.

Our results with 15 orbital cavernomas showed that there are important differences in comparison with cerebral cavernomas: in contrast all orbital cavernomas were embedded by a lilac hard and compact capsule. Clinical symptoms were characterized by the growth of the orbital cavernomas. There were no signs of hemorrhage, which is typical for cerebral cavernomas. The latter showed in contrast to orbital cavernomas a degenerated collagenous tissue forming the vessel walls. The capsule of the orbital cavernomas can be proved by magnetic resonance imaging (MRI). Because of its tendency to lead to irreversible loss of visual acuity, we recommend early surgery after the onset of symptoms.

Intracranial and orbital cavernous angiomas: a review of 74 surgical cases.

We present a surgical series of 74 patients (30 males and 44 females) with pathologically verified cavernous angiomas of the intracranial and orbital compartments. Patients were admitted between 1975 and 1991; six had a family history of cerebral cavernomas, and two had multiple (two) lesions. The 76 malformations were located as follows: 57 were in the cerebral hemispheres, four in the supratentorial ventricles, one was in the middle cranial fossa, two were in the brain stem, five in the cerebellum and seven in the orbits. Seizures and focal neurological deficits, and decrease of visual acuity with exophthalmus, were the main clinical signs observed in patients with intracranial and orbital cavernomas, respectively. Sixteen patients (21.6%) had a clinically significant haemorrhage attributable to the cavernous angioma. A number of these vascular malformations were misdiagnosed by computed tomography. In the last 10 years magnetic resonance imaging has been the most sensitive method for detecting these lesions. Seventy-four of the 76 diagnosed cavernomas were treated surgically: a complete excision was obtained in 68 patients; in two patients with multiple lesions only those causing symptoms were removed. Surgery for the 10 deep lesions was aided considerably by stereotactic localization. Two patients died in the immediate postoperative course. The overall outcome was good in 66 of the 72 remaining patients, resulting in improved seizure control or lessened neurological deficit.