Faculty Collaboration Database

Cavernous hemangioma of the orbital apex: pathogenetic considerations in surgical management. Am J Ophthalmol 2010 Dec;150(6):764-73

Date

11/26/2010

Pubmed ID

21094709

DOI

10.1016/j.ajo.2010.07.027

Scopus ID

2-s2.0-78649466935 (requires institutional sign-in at Scopus site)   55 Citations

Abstract

PURPOSE: To consider the pathogenesis and growth of cavernous hemangioma, particularly within the crowded orbital apex, in decisions regarding surgical indications, timing, and technique.

DESIGN: A perspective based on analysis of the microanatomic relationships and growth potential of apical cavernous hemangiomas, with representative case studies illustrating management recommendations.

METHODS: Analysis of microscopic findings in typical and vision-loss cases; review of tumor growth patterns as reported in observational and interventional studies; consideration of surgical approaches and reported functional outcomes.

RESULTS: An ongoing, local hemodynamic imbalance may drive the proliferation of a cavernous hemangioma. Extension into neighboring tissue induces a fibrous capsule, which is continually reconstituted as the lesion expands, and which may incorporate visually critical structures in the confines of the apex. The extent of this microanatomic intimacy is not detectable preoperatively. The tumor's remaining growth potential at the time of diagnosis or following incomplete resection is not predictable.

CONCLUSIONS: Patients without significant vision deficits should be observed for progression. Those with significant deficits or signs of progression should be offered timely surgery, with recognition of the risks. The surgical approach should be individualized based on macroanatomic relationships. The decision to intervene should not be a commitment to complete resection at any cost; intraoperative recognition of "inoperable" attachments may dictate modifications in order to preserve vision.

Author List

Harris GJ

Author

Gerald J. Harris MD Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Decision Making
Disease Progression
Female
Hemangioma, Cavernous
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Ophthalmologic Surgical Procedures
Orbital Neoplasms
Prospective Studies
Time Factors
Tomography, X-Ray Computed
Vision Disorders
Visual Acuity
Visual Field Tests
Visual Fields