Adjunctive aspiration technique for the surgical management of deep orbital cavernous hemangioma

To propose a needle aspiration technique for the surgical removal of orbital cavernous hemangioma. In this retrospective case series, we enrolled 13 patients with orbital cavernous hemangioma, who underwent excisional surgery assisted with needle aspiration technique from June 2013 to April 2022. Preoperative symptoms, clinical examination, and imaging features were recorded. Surgical outcomes, including the improvement of visual acuity, proptosis, and ocular motility, were assessed. Postoperative complications were also reported. There were 11 female and two male patients, with a mean age of 50.2 ± 8.0 years (range: 38-61 years). The most common symptom was proptosis (12 cases, 92%), followed by blurred vision (6 cases, 46%). The diameter of the lesions was between 1.8 and 3.2 cm on preoperative imaging. The surgical approaches included sub-brow orbitotomy in 11 patients and the inferior transconjunctival approach in two cases. All the tumors were removed successfully after needle aspiration of 1-3 cc of intralesional blood to reduce the tumor size. Preoperative proptosis, blurred vision, and diplopia improved after the surgery in all cases. There were no serious complications or recurrence of orbital hemangioma. The study presented an effective application of the needle aspiration technique in the surgical management of orbital cavernous hemangioma. Such an innovative method can bring significant benefits, especially for those with large cavernous hemangioma within the deep orbital region.