Intraconal Retro-Orbital Cavernous Hemangioma Managed by Endoscopic Transnasal Excision: A Case Report

Cavernous hemangioma is the most common benign vascular lesion of the adult orbit, typically located in the intraconal compartment. Extraconal and medial locations are rare. We report the case of a 59-year-old male presenting with a 10-year history of progressive right eye proptosis associated with diminution of vision. Examination revealed abaxial (down and out) proptosis with mild restriction of ocular motility. Magnetic resonance imaging of the orbit showed a well-defined intraconal retrobulbar mass compressing the optic nerve. The lesion was completely excised via an endoscopic transnasal approach under general anesthesia. Intraoperatively, a vascular, encapsulated intraconal mass was identified beneath the medial and inferior rectus muscles and removed in toto. Histopathology confirmed cavernous hemangioma. Postoperatively, proptosis reduced from 26 mm to 22 mm, and final visual acuity improved from hand movements close to the face to 6/18. The suboptimal recovery in vision was due to foveal thinning owing to the compressive effect of the mass over the years. This case highlights the efficacy of the endoscopic transnasal approach in managing medially located intraconal cavernous hemangiomas. This approach provides excellent visualization, minimal morbidity, and superior cosmetic outcomes.