Endoscopic approaches for the treatment of orbital cavernous hemangiomas: a retrospective multicentric case series.

Abstract

Background: The treatment of choice for orbital cavernous hemangiomas (OCHs) is surgical resection, and multiple approaches have been proposed for these challenging deep-seated lesions of the orbit. In the latest years, endoscopic approaches, as the endonasal (EEA) or the transorbital (ETA), have been suggested as minimally invasive alternatives for these tumors, but few large works in literature are reported. In this article, the experience of three Italian referral centers with the endoscopic treatment of OCHs is described.

Methods: All patients with OCHs operated with an endoscopic approach since January 2015 to January 2024 in 3 Italian referral centers were retrospectively collected. Patients' characteristics and symptoms, OCHs localization and type of endoscopic approach were reported. Postoperative complications, clinical outcome and cosmetic results (evaluated with Clavien-Dindo Classification and Scar Cosmesis Assessment and Rating Scale) at follow-up were assessed.

Results: Thirty-four patients were included, 16 were females. ETA was preferred in 19 patients and EEA in 15. All OCHs of the lateral quadrants were treated with ETA. 14/18 cases located in the medial quadrants were treated with EEA, since in 4 of the supero-medial quadrants lesions, an ETA was preferred. Finally, the orbital apex lesion was treated with EEA. Complete resection was achieved in 31 (91.2%) cases. Complications were transient and consisted in 3 cases of diplopia, 1 of medial rectus palsy and 1 of supraorbital neuralgia, all spontaneously regressed at follow-up. An optimal cosmetic outcome was achieved in all patients both after an EEA and an ETA.

Conclusions: Endoscopic approaches for the treatment of OCHs are a safe and valid surgical option, allowing a complete resection avoiding any brain manipulation. Thanks to their less invasiveness, endoscopic approaches guarantee limited neurological and functional sequalae. Moreover, they resulted well tolerated and ensured good cosmetic outcomes.