Transpalpebral Superolateral Orbitotomy for Orbital Cavernous Hemangioma Extirpation: 2-Dimensional Operative Video

Abstract

Cavernous hemangiomas of the orbit are low-pressure vascular tumors. Usually benign, they become symptomatic by the local mass effect, pushing the eyeball forward, causing exophthalmia, by oculomotor muscle and nerve compression causing diplopia or by optic nerve compression, leading to visual impairment. Radiotherapy is of limited value in their treatment because of the fragility of the optic nerve and subsequent blindness risk. Surgery remains the gold standard and definitive treatment. We illustrate in this video a transpalpebral superolateral orbitotomy and extirpation of an orbital cavernous hemangioma. A 52-yr-old healthy woman was sent for neurosurgical consultation by her ophthalmologist. She described a history of progressive unilateral right exophthalmia in the last months. A cerebral magnetic resonance imaging (MRI) revealed a 2.5-cm-large orbital lesion located superiorly and laterally to the eyeball. Surgery was proposed and accepted by the patient. The frontozygomatic component of the orbital rim needed to be removed to safely extirpate the cavernous hemangioma without exerting unnecessary and risky pressure on the eyeball.1,2 We decided to go for a superolateral orbitotomy via a transpalpebral incision.3 Total removal of the lesion was achieved with no complication. Exophthalmia normalized. Written patient consent was obtained for use and publication of their image after complete information. The patient consented to the surgery.

Commentary: Endoscopic Transorbital Surgery for Trigeminal Schwannoma: Introduction of a Novel Approach: 2-Dimensional Operative Video

“…At present, this approach holds primary indications in orbital and optic canal decompression, as well as for managing medial orbital wall fractures and addressing medial extraconal/intraconal orbital apex lesions, including orbital cavernous hemangiomas. 6…”

“…At present, this approach holds primary indications in orbital and optic canal decompression, as well as for managing medial orbital wall fractures and addressing medial extraconal/intraconal orbital apex lesions, including orbital cavernous hemangiomas. 6 The concept of transorbital neuroendoscopic surgery, 7 introduced in 2010, has established 2 distinct objectives for endoscopic approaches to the orbit: addressing intraorbital pathology and creating minimally disruptive key hole passages to access intracranial compartments. Although still relatively novel with a limited number of global cases, it is essential to acknowledge that this innovative technique carries potential risks, albeit small, such as optic nerve damage and blindness, stemming from manipulation or vasospasm.…”