Transconjunctival approach for orbital cavernous hemangiomas: a report of 39 cases

Objective:To evaluate the efficacy of transconjunctival approach for patients with orbital cavernous hemangiomas, and to understand its relationship with imaging localization. Methods: We retrospectively studied the clinical data of 39 patients with orbital cavernous hemangioma who were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas, the surgical outcomes, and the selection criteria were analyzed. Results: We noticed that all the cavernous hemangiomas in this study were just behind the globe or compressing the globe. CT and MRI showed that all the 39 hemangiomas were located in the muscle cone, round in shape and with well-defined margins. The hemangiomas of 36 patients, which showed slight adhesion and no large draining vein by image examination, were completely resected. One patient with large draining vein was also extirpated completely, but only with visual loss. In the other 2 patients with tight adhesion, most fragments of tumors were removed. The successful rate of operation was 92.3%. The visual acuity increased in 6 of 9 cases with primary visual impairment. All the 32 patients with primary proptosis had their symptoms resolved completely. The treatment outcomes were obvious in 32 (82.1%) patients, remained unchanged in 5 (12.8%) patients, and worsened in 2(5.1%) patients. Conclusion: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, other approaches must be recommended if the tumor is closely attached to the orbital apex, adheres tightly to the retrobulbar tissues, or with large draining veins.