J Korean Ophthalmol Soc.  2010 Mar;51(3):430-434.

The Supraorbital Approach to a Large Retrobulbar Cavernous Hemangioma of the Orbit-One Case Report

• Song IS
• Ko Y
• Lee YJ

Abstract

PURPOSE
To report a complete excision of a large superior orbital retrobulbar cavernous hemangioma using supraorbital craniotomy through the suprabrow approach combined with superior orbital wall removal.
CASE SUMMARY
A 31-year-old woman presented to our clinic with left exophthalmos beginning one month earlier. Visual acuities and intraocular pressures of both eyes were normal and there was no diplopia and no limitation in ocular movement. On exophthalmometry, the right eye was 15 mm and the left eye was 18 mm. CT and MRI demonstrated a superior orbital retrobulbar mass of 2.0x2.6x2.0 cm in size, and the mass displaced the superior rectus and levator palpebrae muscles. After six months, a neurosurgeon attempted a classic supraorbital craniotomy but failed. Fourteen months later, the authors completely excised the tumor through superior orbital wall removal. The tumor was confirmed as a cavernous hemangioma after histopathologic study.
CONCLUSIONS
The authors succeeded in complete excision of a superior orbital retrobulbar cavernous hemangioma using supraorbital craniotomy through a suprabrow approach combined with superior orbital wall removal.

Keyword

Cavernous hemangioma; Exophthalmos; Supraorbital craniotomy

MeSH Terms

Adult
Caves
Craniotomy
Diplopia
Exophthalmos
Eye
Female
Hemangioma, Cavernous
Humans
Intraocular Pressure
Muscles
Orbit
Visual Acuity

Figure

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  Figure 1. Fourteen months after classic supraorbital craniotomy failed, CT scan with enhancement was obtained. (A) Sagittal view. The mass is well marginated, sized by 2.0×2.6×2.4 cm. (B) Coronal view. The mass deviates the optic nerve downward and abuts on the superior rectus muscle. Contrasted study shows that the mass is enhanced at the delayed phase.

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  Figure 2. A and B. Six months after the tumor was removed, CT scan with enhancement was obtained. There is no evidence of tumor remnant or tumor recurrence.

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  Figure 3. Histopathological findings representing a cavernous hemangioma of the orbit. Hematoxylin and eosin stain (×100).

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  Figure 4. A and B. On the first postoperative day, the patient shows complete ptosis and severe upper gaze limitation in the left eye. C and D. After 6 months, the patient shows mild ptosis and normal upper gaze movement.

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  Figure 5. Diagram of a supraorbital craniotomy combined with superior orbital wall removal is outlined using dotted blue line on a three-dimensional CT reconstruction image. (Black line means incision line of classic supraorbital craniotomy, black ellipse means burr hole in the temporal fossa and red circle means the tumor).

Reference

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