title: Transconjunctival orbitotomy for orbital cavernous hemangiomas.
abstract: BACKGROUND
  Orbital cavernous hemangiomas, particularly those within the retrobulbar space, are approached by neurosurgeons as well as by ophthalmic surgeons. Several surgical techniques have been applied over the past decades. Less traumatic approaches in this functionally and cosmetically important region are desirable. We describe a transconjunctival approach in 39 patients with orbital cavernous hemangiomas.
  
  
  METHODS
  Thirty-nine patients with orbital cavernous hemangiomas were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas were analyzed in the course of their appropriate treatment.
  
  
  RESULTS
  In all patients, cavernous hemangiomas were just behind the globe or were compressing it. Computed tomography and magnetic resonance imaging showed orbital cavernous hemangiomas as round, well-defined intraconal masses. In 37 cases, the tumors were removed intact, and only 1 patient suffered permanent vision loss as a result of intraoperative hemorrhage. In the other 2 cases, the tumor fragments were incompletely removed. Visual acuity increased in 6 of the 9 cases with primary visual impairment. Thirty-two patients with primary proptosis were resolved completely. Six patients with visual field defect were also improved.
  
  
  CONCLUSIONS
  Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, if the tumor is close to, or touching, the orbital apex, adhering tightly to retrobulbar tissue, or combined with large draining veins, operation through other approaches must be considered.
authors.affiliation: Department of Ophthalmology, Second Affiliated Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jin-Wei
authors.initials: JW
authors.lastname: Cheng
authors.forename: Rui-Li
authors.initials: RL
authors.lastname: Wei
authors.forename: Ji-Ping
authors.initials: JP
authors.lastname: Cai
authors.forename: You
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000601:surgery; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity