Treatment and long-term outcome of patients with orbital cavernomas.
OBJECTIVE
To evaluate the long-term prognosis of visual function in patients with orbital cavernomas after conservative and surgical treatment.


METHODS
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.


CONCLUSIONS
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.
Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany. Alexander.Scheuerle@med.uni-heidelberg.de
Alexander Friedrich
AF
Scheuerle
Hans H
HH
Steiner
Gerold
G
Kolling
Stefan
S
Kunze
Alfred
A
Aschoff
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity / Q000502:physiology