Abstract Listings 2026

Purpose

A cavernous venous malformation of the orbit, formerly known as a cavernous hemangioma, is the most common primary orbital tumor in adults. It is seen more frequently in women and usually presents during the fourth to fifth decades of life. Surgical treatment is generally required in case of symptomatic . When surgical instruments apply anterior pressure, these smooth, encapsulated tumors frequently escape and displace posteriorly into the deep orbital fat.

Methods

Our case report demonstrates how performing the procedure under local anesthesia allows the surgeon to leverage the patient’s active cooperation via the Valsalva maneuver to counteract this mobility and facilitate safe tumor retrieval.

Results

A female patient presented for surgical intervention with a presumptive preoperative diagnosis of an orbital cyst. The procedure was initiated under local anesthesia via a transcutaneous approach. However, upon surgical exposure, the lesion was intraoperatively identified not as a cyst, but as a highly mobile orbital hemangioma. Attempts to grasp and dissect the tumor caused it to repeatedly slip away and displace posteriorly. To overcome this mechanical challenge, the awake patient was instructed to perform a controlled Valsalva maneuver. The resulting transient increase in orbital venous pressure successfully pushed the hemangioma anteriorly and stabilized it against the surgical field. This forward displacement allowed the surgeon to easily capture, secure, and completely extirpate the tumor. The patient recovered uneventfully with excellent outcomes.

Conclusion

this case demonstrates the potential of using local anesthesia combined with an intraoperative Valsalva maneuver as an alternative approach for mobile orbital hemangiomas. Active patient cooperation provides controlled physiological propulsion that counteracts tumor mobility and stabilizes the lesion. This technique simplifies intraoperative capture, improves surgical access, and may offer a safer, less invasive option for managing these otherwise elusive tumor

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