Orbital Cavernomas

Orbital cavernomas are the most frequent intraconal, intra-orbital primary tumor in adults. They are low-flow venous malformations composed of a cluster of endothelium-lined vascular sinusoidal channels. The most common presenting symptoms are painless progressive axial proptosis, visual acuity disturbances, eye movements dysfunction, and diplopia. Unlike other intracranial cavernous malformation, bleeding is rare. Observation may be a valid option in asymptomatic cases. Radiosurgical treatment has also been reported. Surgery is the treatment of choice for patients with blurred vision, cosmetically disfiguring proptosis or in cases with evidence of active growth. Several approaches have been described and are commonly used: anterior transconjunctival approach, lateral orbitotomy approach according to Kronlein, endonasal endoscopic approach and transcranial fronto-orbital approach. Topographical classifications of tumor location inside the orbit can help in the choice of the most safe and effective approach.