A 40 year old lady started noticing her left eye becoming more prominent since about a year and increasing. On examination she was found to have proptosis (protrusion) of the left eye. A CT Scan showed a well defined intra-conal mass behind the eye (Supero-medial orbit). A left trans-conjunctival orbitotomy was performed thereby avoiding an external scar. The mass was found to be a vascular benign tumour or malformation called cavernous hemangioma or cavernous venous malformation.
Additional Trivia : As per latest ISSVA classification, cavernous hemangiomas is described as a slow flow venous malformations. Despite being a misnomer now, cavernous hemangioma is still used popularly used.
Orbitotomy is one of my favourite surgical procedures. A tumour behind the eye can be removed by a single surgery with a small incsion and low morbidity to the patients. Cavernous hemangioma is the commonest benign orbital tumour in adults.
In an earlier era, these tumours would be removed via a craniotomy (brain surgery) by neurosurgeons or a disfiguring open surgery sometimes causing the loss of vision in the involved eye by other surgeons- that’s way too much morbidity for a benign tumour. But with the advent of modern day techniques and skilled oculoplastic surgeons performing orbitotomy today to remove such tumours, this surgery’s risks and complications is very low with the added advantage of a scarless as well as without even having to remove bone. This surgery is followed by a mostly uneventful recovery period.
Swipe away on the instagram post below to see more radiological details of the tumour as well as to see how the tumour looks intra-operatively and finally how it looks under a microscope.
Pic 1: Photos at presentation (above) and 6 weeks after surgery. Surgery was done without an external skin incision by using a trans-conjunctival, retro-caruncular approach from the supero- medial fornix.
Pic 2: Pre-operative CT images with clinical correlation. Shows a well defined supero-medial orbital mass indicating cavernous hemangioma as a top differential.
Pic 3 : Intra-operative mass exposure confirms our pre-operative diagnosis. The image shows the bluish red solid tumour- #CavernousHemangioma in relation to the globe.
Pic 4 : Histopathology of the tumour: The microscopic picture shows large dilated vessels with thin walls consistent with the diagnosis of cavernous hemangioma.