Lateral Orbitotomy Cryo-Assisted Removal of Orbital Cavernous Hemangiomas: Case Report and Technical Hints

Orbital cavernous hemangiomas are the most common adult benign vascular orbital neoformation, representing 5%-15% of all orbital masses, and may involve the extraconal or intraconal space.¹ According to the International Society for the Study of Vascular Anomalies, orbital cavernous hemangiomas should be classified as low-flow nondistensible venous malformations and are characterized by slow growth, generally 0.2 cm³/year.^2,3 For these characteristics, complete surgical resection is necessary for symptomatic patients or in case of significant volumetric increase in its size.⁴Video 1 demonstrates the cryo-assisted removal of an intraconal orbital hemangioma (22 × 26 mm) located in the superior-lateral aspect of the right orbit in a 55-year-old woman. The patient presented with right exophthalmos and diplopia on right lateral gaze. The lesion was completely removed using a right lateral orbitotomy combined with a superior eyelid endoscopic-assisted approach. Intraoperative neuronavigation was used to correctly identify the location of the orbital hemangioma. Exophthalmos resolved postoperatively, without any cosmetic sequelae or visual impairment. Magnetic resonance imaging performed 8 months after surgery demonstrated excellent surgical outcomes, with complete resolution of the exophthalmos and without evidence of persistence of disease. A multidisciplinary approach, involving different specialists familiar with orbital anatomy and physiology, is fundamental in the management of these rare orbital pathologies.