Risks and Benefits of Surgical Excision of Orbital Cavernous Venous Malformations (So-Called Cavernous Hemangioma): Factors Influencing the Outcome

Strianese, Diego; Bonavolontà, Giulio; Iuliano, Adriana; Mariniello, Giuseppe; Elefante, Andrea; Liuzzi, Raffaele

doi:10.1097/iop.0000000000001767

Cited by 14 publications

(26 citation statements)

References 47 publications

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“…Because these kinds of OCVMs are small and deep, the operation is difficult, and the complication rate is high. The surgical indications are questionable (8); however, we should be highly alert during the clinical follow-up regarding sudden visual loss caused by OCVM rupture and haemorrhage. The authors of the present study believe that when OCVMs (such as Types I and II) rupture and haemorrhage or the patient has a sudden vision loss, positioning and qualitative diagnosis before surgery are crucial.…”

Section: Introductionmentioning

confidence: 99%

Prognosis Analysis and Clinical Features of Orbital Cavernous Venous Malformations With Refractory Insidious Onset

Yang

Liu

et al. 2022

Front. Oncol.

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ObjectiveThe present study aims to analyse the clinical presentation, treatment and prognosis of a group of patients with orbital cavernous venous malformation (OCVM) with an insidious onset.MethodThe clinical data of 35 patients with OCVM treated at our centre between 2003 and 2020 were retrospectively analysed. The OCVMs were classified as one of six types (I–VI) according to the orbital position of the tumour. The clinical characteristics, treatment methods and follow-up results were recorded.ResultsA total of 35 patients with OCVM under the optic nerve sheath in the orbital apex area or the common tendon ring (Types I and II) were included in the present study. In 20 cases (57.1%), patients were misdiagnosed with optic neuritis, and in 20 cases (57.1%), the tumour was not identified based on imaging. The presentation was acute or subacute in 23 cases (65.7%). All patients underwent surgery: transnasal surgery in 22 cases (62.9%) and craniotomy in 13 cases (37.1%). A total of 9 patients (25.7%) experienced postoperative complications, and 17 patients (48.6%) experienced vision improvement. The average patient age at first diagnosis was 43.3 ± 10.3 years, and the median follow-up period was 64.5 months. Overall, 14 patients (40%) experienced postoperative complications: postoperative blindness in 6 cases, postoperative vision loss in 8 cases and orbital apex syndrome in 7 cases.ConclusionPatients with Type I and Type II OCVMs are the most complex cases. They have an insidious onset and are associated with a high rate of misdiagnosis and missed diagnosis. Acute and subacute decreases in visual acuity are mainly caused by OCVM haemorrhage. The difficulty of surgical treatment and the poor prognosis of postoperative vision are characteristics of this tumour. Transnasal surgery and craniotomy can be used to remove OCVMs located in the common tendon ring or optic canal as well as those involving the intracranial area through the supraorbital fissure. Meanwhile, the orbital approach (orbitotomy) has proven to be an effective method of treating OCVMs not involving the deep orbital apex and intracranial area.

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Section: Introductionmentioning

confidence: 99%

Prognosis Analysis and Clinical Features of Orbital Cavernous Venous Malformations With Refractory Insidious Onset

Yang

Liu

et al. 2022

Front. Oncol.

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“…Although the size of some OCVMs appears stationary, they can show a wide variation in growth pattern; [4][5][6][7][8][9][10][11] one reported estimate for the growth rate of progressive lesions is ~0.2 ml per year. 10 Most OCVMs remain stable or decrease in size in postmenopausal women (with reduced serum estrogen or progesterone) 13 and this, together with the female predominance, suggests that hormonal factors may influence the growth of OCVMs.…”

Section: Discussionmentioning

confidence: 99%

Presenting Characteristics for Symptomatic, as Compared to Asymptomatic (assumed), Orbital Cavernous Venous Malformations

Vahdani

Rose

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Aims: To compare the characteristics for symptomatic and asymptomatic orbital cavernous venous malformations (OCVMs). Methods: A retrospective case-note review for patients with OCVMs was performed for demographics and presenting features. Results: Four hundred and fourteen patients (258 female; 62%) presented at a mean age of 49.4 years and all were unilateral. Ninety-two (22%) asymptomatic OCVMs were found a decade later than 322 symptomatic patients (57.8 vs. 47.0 years; p < 0.001). Patients with symptomatic OCVMs had an average symptom duration of 3.3 years with the commonest being altered vision (57%), proptosis (55%), orbital ache (21%), and diplopia (13%). Visual obscurations were reported by 11% of symptomatic patients, whereas 30% had a hyperopic shift. Mean LogMAR was 0.39 for symptomatic OCVMs and 0.1 for asymptomatic (p < 0.001), and a relative afferent pupillary defect was detected in 38% symptomatic and 7% asymptomatic patients (p < 0.001). Mean relative exophthalmos was 3.9 mm in symptomatic patients and 1.5 mm in asymptomatic (p < 0.001), but there was no correlation between age and exophthalmos. Symptomatic lesions had higher rates of nonaxial displacement (30% vs. 7%; p < 0.00001), more palpable masses (17% vs. 2%; p = 0.0001), and more impairment of motility (29% vs. 10%; p = 0.0024). Fundal abnormalities were noted in 63% of patients with symptomatic OCVMs, as compared to 26% of asymptomatic (p < 0.0001). Conclusion: Symptomatic OCVMs may present with reduced visual function, either due to the globe or optic nerve compression, or proptosis. Asymptomatic (presumed) OCVMs— representing 22% of all OCVMs—are usually found a decade later than symptomatic lesions, and a few may have only mild functional impairment.

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“…There are several reports about the removal of benign retrobulbar masses (particularly cavernous hemangiomas) with or without lateral osteotomy, but none have described the rather specialist techniques required for intact removal of lacrimal gland tumors in the absence of osteotomy. 13–15…”

Section: Discussionmentioning

confidence: 99%

Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy

Parker

Vahdani

Rose

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland.Methods: Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland's orbital lobe on an intact sheet of periosteum, an anterior "flip" of the mass (out of the orbit, past the orbital rim) "hinged" at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass.Results: Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19-85 years) and 51.1 years without (median, 50.3; range, 11-81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6-15.0 ml with osteotomy; 0.9-15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size.Conclusions: In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.

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Risks and Benefits of Surgical Excision of Orbital Cavernous Venous Malformations (So-Called Cavernous Hemangioma): Factors Influencing the Outcome

Cited by 14 publications

References 47 publications

Prognosis Analysis and Clinical Features of Orbital Cavernous Venous Malformations With Refractory Insidious Onset

Prognosis Analysis and Clinical Features of Orbital Cavernous Venous Malformations With Refractory Insidious Onset

Presenting Characteristics for Symptomatic, as Compared to Asymptomatic (assumed), Orbital Cavernous Venous Malformations

Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy

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