By Dr. Juan Maza-Solano
Orbital cavernous hemangioma (OCH) is a benign vascular tumor that grows slowly, representing 9,5% to 15% of primary expansive lesions of the orbit, with a peak incidence around 40-50 years of age. Long-standing proptosis is the most common clinical finding. In this article, we will explore the endonasal endoscopic approach as a safe and effective technique for the treatment of HCO, with special emphasis on surgery performed by the Dr. Juan Maza-Solano, in collaboration with the Dr. Ariel Kaen, which you can see in the Surgical training app SURGSCHOOL, available on IOS and Android.
Exploring the Endoscopic Endonasal Approach: Advances in the Treatment of Orbital Cavernous Hemangioma
The endoscopic endonasal approach has become a prominent surgical technique for the removal of orbital lesions, especially in cases of cavernous hemangiomas. This approach offers several advantages, including lower morbidity, faster recovery, and better preservation of ocular function compared to traditional surgical techniques.
The procedure begins with complete exposure of the lamina papyracea, allowing adequate access to the tumor site. A complete ethmoidectomy and reaming of the orbital palatine process is performed to provide optimal working space. During dissection, it is crucial to interrupt the lacrimal sac carefully to avoid postoperative epiphora.
Once the tumor site is exposed, the lamina papyracea is opened, which medializes the lesion and makes it accessible for endonasal removal. The tumor is located between the superior oblique and middle rectus muscles, with the latter rejected inferiorly to facilitate dissection.
During tumor removal, meticulous dissection is carried out to preserve the plane of the fibrous surface of the hemangioma, which helps prevent bleeding from the collateral branches of the ophthalmic artery. The tumor is removed in a single block through the nostril, ensuring complete removal and less manipulation of surrounding tissue.
A notable aspect of this procedure is that the surgical bed remains bloodless, which minimizes the risk of intraoperative complications and accelerates postoperative recovery. To prevent any residual bleeding, the surgical bed is plugged with a Surgicel-type resorbable material.
