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Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients

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Abstract

Purpose

The aim of this study is to assess the efficacy and safety of surgical treatment of orbital cavernomas in terms of clinical and functional results.

Methods

Twenty consecutive patients underwent surgical removal of a unilateral orbital cavernoma between 1999 and 2009. Indications for surgical treatment were: visual impairment, diplopia due to ocular movement impairment, progressive and disfiguring unilateral proptosis, severe retroorbital pain clearly related to the orbital cavernoma. We used a topographic classification of the lesions within the orbit. The orbit has been divided into an anterior and a posterior compartment on the axial plane and into three sectors on the coronal plane. The proptosis was quantified on MRI scans.

Results

The location of the cavernoma determined the choice of the surgical approach. We performed eight lateral orbitotomies and 12 fronto-orbito-zygomatic approaches. All the tumors were completely removed as assessed at follow-up MRI. We did not record any intraoperative or major postoperative complication requiring a reoperation. The postoperative visual acuity improved in four of five patients with visual impairment, it worsened in the other case. Proptosis improved in all the patients. Diplopia improved in four patients, and did not recover in another case.

Conclusion

Surgical treatment of symptomatic orbital cavernomas is safe and effective. Tumor location dictates the choice of surgical approach. Visual function and cosmetic result are the main parameters to evaluate the clinical outcome. Surgical approach and dissection technique are crucial in determining the visual outcome.

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Acknowledgments

Acknowledgments to Elisa Melzi, M.D. and Stefania Bianchi Marzoli, M.D. for their collaboration in the analysis of patients' visual outcome.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Nicola Boari, Filippo Gagliardi, Paola Castellazzi & Pietro Mortini

Authors
  1. Nicola Boari
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  2. Filippo Gagliardi
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  3. Paola Castellazzi
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  4. Pietro Mortini
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Corresponding author

Correspondence to Nicola Boari.

Additional information

Comment

This is an interesting report on a single-institution, single-surgeon experience on a relatively large series of orbital cavernomas.

The authors provide a useful update on techniques and surgical outcomes for these rare lesions.

The results of surgeries are discussed in details providing convincing evidence for an aggressive surgical attitude towards lesions producing ocular symptoms or deficits. I appreciated the topographical classification proposed by the authors and its surgical implications. This reviewer fully agrees with the choice of “neurosurgical” approaches versus other routes that may seem at first glance less invasive, such as the transconjunctival one. In this respect, the authors emphasize the importance of orbital decompression before tumor dissection.

Domenico d'Avella

Padova, Italy

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Boari, N., Gagliardi, F., Castellazzi, P. et al. Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients. Acta Neurochir 153, 491–498 (2011). https://doi.org/10.1007/s00701-010-0808-1

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  • DOI: https://doi.org/10.1007/s00701-010-0808-1

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