Orbital Cavernous Hemangioma

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Cavernous hemangiomas are the most common intraorbital tumors found in adults. These benign, vascular lesions are slow growing and can manifest as a painless, progressively proptotic . Most of these tumefactions are exceedingly unilateral. Bilateral cases have been reported but are rare.

Orbital cavernous angiomas can increase intraorbital volume with a resultant mass effect. Although cavernous hemangiomas are histologically benign, they can encroach on intraorbital or adjacent structures and can be considered anatomically or positionally malignant. Visual acuity or field compromise, diplopia, and extraocular muscle or pupillary dysfunction can result from compression of intraorbital contents by the angioma. Lagophthalmos can result in exposure keratopathy, keratitis, and corneal perforation.

International

Henderson reported an incidence of 4.3% among orbital neoplasms. [1]

The morbidity associated with cavernous hemangiomas is the threat of compressive optic , extraocular muscle dysfunction, and cosmetic disfigurement.

Mortality can result from intraoperative complications, such as and the risk of general anesthesia.

No predilection exists for race or ethnicity.

Harris and Jakobiec found a 7:3 occurrence ratio of women to men, while Henderson reported an almost equal ratio, 8:7 in women and men. [2, 1]

Patients usually manifest symptomatically during the third to fifth decades of life.

Henderson GW. Vascular hamartomas, hyperplasias, and neoplasms. Henderson GW, ed. Orbital Tumors. New York: Raven Press; 1994. 94-100.

Harris GJ, Jakobiec FA. Cavernous hemangioma of the orbit: a clinicopathologic analysis of sixty-six cases. Jakobiec, ed. Ocular and Adnexal Tumors. Birmingham, Ala: 1978. 741-81.

Zauberman H, Feinsod M. Orbital hemangioma growth during pregnancy. Acta Ophthalmol (Copenh). 1970. 48(5):929-33. [Medline].

Ko F, Dibernardo CW, Oak J, Miller NR, Subramanian PS. Confirmation of and differentiation among primary vascular lesions using ultrasonography. Ophthal Plast Reconstr Surg. 2011 Nov. 27(6):431-5. [Medline].

Boari N, Gagliardi F, Castellazzi P, Mortini P. Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients. Acta Neurochir (Wien). 2011 Mar. 153(3):491-8. [Medline].

Cho KJ, Paik JS, Yang SW. Surgical outcomes of transconjunctival anterior orbitotomy for intraconal orbital cavernous hemangioma. Korean J Ophthalmol. 2010 Oct. 24(5):274-8. [Medline]. [Full Text].

Liu X, Xu D, Zhang Y, Liu D, Song G. Gamma surgery in patients harboring orbital cavernous hemangiomas that were diagnosed on the basis of imaging findings. J Neurosurg. 2010 Dec. 113 Suppl:39-43. [Medline].

Dortzbach RK, Kronish JW. Orbital disease. Dortzbach RK, ed. Ophthalmic Surgery Prevention and Management of Complications. New York: Raven Press; 1994. 312-25.

Harris GJ, Jakobiec FA. Cavernous hemangioma of the orbit. J Neurosurg. 1979 Aug. 51(2):219-28. [Medline].

Mercandetti M, Cohen AJ. Exophthalmos. Medscape Reference [serial online]. February 7, 2007. [Full Text].

Mercandetti M, Cohen AJ. Tumors, orbital. Medscape Reference [serial online]. February 7, 2007. [Full Text].

Rodgers IR, Grove AS. Vascular lesions of the orbit. Principles and Practice of Ophthalmology. Philadelphia: WB Saunders; 1994. 1970-1.

Shields JA, Shields CL. Vascular and hemorrhagic lesions. Atlas of Orbital Tumors. Philadelphia: Lippincott, Williams and Wilkins; 1999. 50-56.

Yan J, Wu Z. Cavernous hemangioma of the orbit: analysis of 214 cases. Orbit. 2004 Mar. 23(1):33-40. [Medline].

Adam J Cohen, MD Physician/CEO, Eyelid and Facial Surgery and MediSpa

Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Mimedx.

Michael Mercandetti, MD, MBA, FACS Private Practice

Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Sarasota County Medical Society, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

David A Weinberg, MD, FACS Director, Oculoplastic and Orbital Surgery, Assistant Professor of Neurology and Ophthalmology, Department of Surgery, Division of Ophthalmology, Fletcher Allen Health Care

Disclosure: Nothing to disclose.

Orbital Cavernous Hemangioma

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