Efficacy and safety of a navigation-assisted, multi-approach endoscopic surgical strategy for orbital apex cavernous hemangiomas.

OBJECTIVE: To evaluate the efficacy and safety of a tailored, navigation-assisted endoscopic surgical strategy for the removal of orbital apex cavernous hemangiomas, utilizing multiple approaches based on tumor location relative to the optic nerve. METHODS: This retrospective case series analyzed ten consecutive patients who underwent surgical removal of orbital apex cavernous hemangiomas. Preoperative evaluation included MRI and/or CT scans to determine the tumor's precise location. An individualized surgical plan was developed for each patient. Tumors medial to the optic nerve were removed via a navigation-assisted endoscopic transnasal approach (n=8). One tumor located superior to the optic nerve was resected via an endoscopic transsupraorbital (eyebrow) approach. One tumor lateral to the optic nerve was removed via an endoscopic lateral orbitotomy. We collected and analyzed data on patient demographics, tumor characteristics, surgical details, pre- and postoperative visual acuity (VA), intraocular pressure (IOP), eye motility, and complications. RESULTS: All ten tumors were successfully resected, with pathology confirming cavernous hemangioma in all cases. The mean preoperative decimal VA was 0.304 ± 0.218, which significantly improved to 0.546 ± 0.314 at the 3-month postoperative follow-up (p = 0.0174, paired t-test). The median preoperative decimal VA was 0.25 (IQR, 0.1-0.48), which significantly improved to 0.55 (IQR, 0.3-0.9) at the 3-month postoperative follow-up (p = 0.0117, Wilcoxon signed-rank test). Sixty percent of patients (n=6) experienced a significant improvement in VA, while 40% (n=4) remained stable. No patients experienced a worsening of vision. Transient postoperative diplopia or ophthalmoplegia occurred in 80% of patients (n=8), but all resolved completely by the final follow-up, with all patients achieving normal eye motility. There were no cases of permanent vision loss, cerebrospinal fluid leakage, or other major complications. CONCLUSION: Based on strict, anatomy-driven patient selection, a tailored surgical strategy for orbital apex cavernous hemangiomas, utilizing navigation-assisted endoscopic approaches, is an effective and safe treatment modality for well-circumscribed lesions. This individualized approach maximizes tumor accessibility, minimizes surgical trauma, and leads to excellent visual outcomes with a low risk of permanent complications.