Cavernous Hemangioma
Jump To
A cavernous hemangioma is a vascular tumor made up of large and dilated blood vessels similar in appearance to caverns. Orbital hemangiomas are benign and slow-growing. Growth involves the vascular structures in the muscles within the orbit, which can push the eyeball forward and result in bulging eyes, or proptosis. These tumors are most frequently found in women ages 20-40 years old and are usually unilateral.
Symptoms of Cavernous Hemangioma
An increase in the volume of the orbital contents may result in cavernous hemangioma symptoms. Growth occurs through painless, slowly progressing proptosis. Patients may experience reduced visual acuity and decreased visual field. This is caused by optic nerve and extraocular muscle involvement along with mass effect. It is possible that patients may experience double vision, inability to shut their eyes, and pupillary dysfunction due to involvement of neural structures within the orbit.
Diagnosis of Cavernous Hemangioma
At Idaho Eyelid and Facial Plastic Surgery, a detailed history, review of symptoms, and thorough examination will be performed to diagnose cavernous hemangiomas. Diagnostic tools are used to determine the extent of proptosis and optic nerve compression. These include hertel exophthalmometry, vision/visual field exams, and pupillary and extraocular muscle function tests. If cavernous hemangioma is suspected, orbital imaging studies may be utilized to confirm the diagnosis.
Imaging of Cavernous Hemangioma
MRI is the preferred method to image cavernous hemangiomas. Images typically show a well-defined lesion with a cauliflower-type appearance on T2-weighted sequences. This can occur with a hypointense rim signifying hemosiderin deposition, which, more simply stated, indicates a higher likelihood of blood-filled spaces within the lesion.
Treatment of Cavernous Hemangioma
Many cavernous hemangiomas do not require treatment; however, tumor size and location matter. Excision may be required for those hemangiomas causing bleeding, growing, or resulting in other symptoms (such as double vision). For hemangiomas in the anterior two-thirds of the orbit, tumors are resected using the anterior eyelid, transconjunctival, or transcaruncular approach. For posterior lesions, a lateral orbitotomy may be more successful. A transcranial method is employed for tumors involving the orbital apex. Complete excision results in favorable vision outcomes, but incomplete excision may result in recurrence. Visual loss can be a complication of surgery, albeit rare.
Pathology of Cavernous Hemangioma
Pathologically, cavernous hemangiomas present as a cluster of thin-walled and dilated blood cells lined with endothelial cells. They are separated by fibrous connective tissue and develop large cavernous spaces filled with blood. Cavernous hemangiomas are usually well-encapsulated and well-tolerated.
