Small cavernous hemangioma of the orbit: diagnosis and treatment tactics

Background. Cavernous hemangiomas are the most common benign neoplasms of the orbit, whose treatment is surgery only. However, the optimal management of patients with small cavernous hemangiomas, which most often are an occasional finding, has not been developed to date. Purpose. To develop an optimal treatment tactics for patients with small cavernous orbital hemangiomas. Material and methods. From 2015 to 2017 92 patients with cavernous hemangiomas of orbit (average age 46.4±3.6 years) were examined and treated in the department of ophthalmic oncology and radiology of the Helmhotz Moscow Research Institute of Eye Diseases. Seventeen (18.5%) patients (3 men, 14 women) had small lesions localized in the internal surgical space perineurally. Before surgery, all patients underwent a complex examination: ultrasound with a color Doppler mapping mode, computed tomography and / or a magnetic resonance imaging of the orbit, while spectral optical coherence tomography (morphometry) was performed before and after the operation. Transconjunctival (11) and transcutaneous (6) orbitotomy were performed. Diagnoses were histologically confirmed. The observation period was 1.8±0.6 years. Results. Clinical symptoms were absent in 13 of 17 patients. CT and MRI scans showed a local heterogeneous lesion with distinct contours of a round or oval shape with an average density of 46.77±11.7 HU with an average diameter of 6±1.8 mm, located paraneurally at the posterior pole of the eye, in the central part and at the apex of orbit. The volume of cavernous hemangioma defined by Doppler was 1 cm3 (13x12x12 mm). Comparative analysis of Doppler characteristics of regional blood flow did not reveal asymmetry in the parameters between the lesion and normal orbital tissue (p>0.05). Morophometric parameters before surgery were normal. In the postoperative period 8 patients showed good mobility of the eyeball in all directions, the upper eyelid was raised, the visual functions were preserved. Morphometry revealed thickening of macular retina (up to 230±18 μm, in average, p>0.05) and the peripapillary layer of nerve fibers (on average 120±14 μm, p>0,05) in all quadrants. Deviation and limitation of eye mobility, ptosis of the upper eyelid were seen in 3 of 17 patients in the early postoperative period, morphometry showed increased thickness of the macular retina (up to 234±19 μm, in average, p>0.05) and peripapillary layer of nerve fibers (122±16 microns, p>0,05) in all quadrants. Dilation of the pupil and decreased visual acuity by 0.4±0.02 were detected in 6 of 17 patients. Macular edema of the retina with an increased thickness to an average of 326±12.8 μm (p<0.001) was found in the ocular fundus, with thickening of the peripapillary layer of nerve fibers (average 230±19 μm; (p<0.001) in all quadrants. Improvement in visual acuity and morphometric criteria was observed at 3 months after intensive therapy.

Conclusion. 1. Patients with small orbital paraneural cavernous hemangiomas are subjected to orbitotomy in case of the presence of clinical symptoms, tumor size of 1 cm3 (13x12x12mm), confirmed by CT and MRI, decreased blood flow velocity characteristics and increased peripheral vascular resistance indices. 2. The use of morphometry before the operation and in the early and late postoperative period after orbitotomy may preserve visual functions. 3. Personalized planning of treatment using modern visualization methods is essential for patients with cavernous hemangiomas of the orbit.

Keywords: small cavernous hemangioma, orbitotomy, color Doppler mapping, ultrasound, spectral optical coherence tomography

The authors declare no conflict of interest. Source of financing: not specified.

For citation: Saakyan S.V., Gusev G.A., Myakoshina E.B., Alihanova V.R. Small cavernous hemangioma of the orbit: diagnosis and treatment tactics. Head and neck Russian Journal. 2019;7(2):18–27 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.