Orbital Apex Hemangioma- Surgical Approach
Author: nur khatib
Base Hospital / Institution: ha Emek Medical Center, Afola, Israel
ePoster presentation
Abstract ID: 25-310
Purpose
Orbital apex hemangiomas, predominantly cavernous hemangiomas, present significant surgical challenges due to their deep location, proximity to critical neurovascular structures, and potential for vision-threatening complications. The choice of surgical approach is determined by tumor location, size, and relationship to surrounding anatomy.
Methods
traditional approaches include transcranial (craniotomy-based), lateral orbitotomy, and more recently, minimally invasive endoscopic techniques. The transcranial approach, often favored by neurosurgeons, provides wide exposure and is particularly suited for lesions involving or closely abutting the orbital apex, allowing for en bloc removal and minimizing intraoperative bleeding. Lateral orbitotomy is generally reserved for lesions in the lateral compartment that do not involve the apex. The advent of endoscopic transnasal approaches has expanded surgical options, offering a direct route to the inferomedial orbital apex with reduced morbidity and improved visualization, especially for tumors medial or inferior to the optic nerve
Results
Surgical outcomes are generally favorable, with most patients experiencing improvement in proptosis and ocular motility. However, the risk of visual impairment and other complications remains, particularly when the tumor is adherent to critical apical structures. Endoscopic approaches, when anatomically feasible, can reduce surgical trauma and complications while maintaining efficacy. Multidisciplinary collaboration between ophthalmology, neurosurgery, and otolaryngology is essential for optimal management
Conclusion
The management of orbital apex hemangiomas requires individualized surgical planning. While transcranial approaches remain standard for deeply seated or apical lesions, endoscopic transnasal surgery is emerging as a safe and less invasive alternative for select cases, offering direct access and favorable outcomes with careful patient selection
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