Further Outpatient Care
Most patients with cavernous hemangiomas can be observed clinically with semiannual or annual formal visual field testing and dilated funduscopic examinations.
Complications
Complications are related to the angiomas mass effect within the orbit. Axial proptosis, extraocular muscle dysfunction, and compressive optic neuropathy are the sequelae that can transpire secondary to enlarging cavernous hemangiomas.
Prognosis
Most cavernous hemangiomas remain stable throughout a patient's life and cause no visual compromise.
If surgical intervention is warranted, most lesions excised in the hands of an experienced surgeon have an excellent prognosis and result in a low morbidity. There is no recurrence following excision or risk of malignant transformation.
Patient Education
Patients should have a clear understanding of the immediate need for follow-up care if a visual disturbance occurs or if proptosis increases significantly.
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Extirpation of an orbital cavernous hemangioma. Note en bloc removal and preservation of capsule. Courtesy of Robert Alan Goldberg, MD.
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MRI demonstrates enhancing mass in apex of left orbit. White arrow points to the superior portion of the optic nerve, showing its deviation. Mass was pressing on superotemporal optic nerve and displacing it inferomedially at apex. Patient had 6 months of progressive decreased vision and visual field loss. Courtesy of M. Duffy, MD, PhD.
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In A, final preoperative visual field of same patient as in Media file 2, demonstrating significant inferior altitudinal field loss; in B, postoperative visual field at approximately 3 weeks after orbital apex decompression and removal of mass; and in C, postoperative visual field at approximately 6 months.
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Intraoperative photo of same patient as in Media file 2. Neurosurgical service performed craniotomy and decompression of the superior orbital fissure and optic canal (yellow arrows) at request of ophthalmology service. Orbital surgery service then opened the periorbita over a bulge (double black arrows) between optic nerve and cranial nerves (single black arrow) and bluntly dissected out mass. Pathology confirmed mass as a cavernous hemangioma. Cranial nerves V and IV were adhered, and careful blunt separation was performed. Postoperatively, a small left hypertropia resolved over 6 weeks. Courtesy of M. Duffy, MD, PhD.
