Endoscopic Endonasal Excision of a Cavernous Hemangioma of the Orbital Apex with Cryoprobe Assistance: Two-Dimensional Surgical Video

Cavernous hemangiomas (CHs) represent the commonest benign orbital lesion in adults, accounting for nearly 6% of overall orbital tumors.¹The most common presenting symptoms include unilateral visual deficits, diplopia, ocular muscle impairment, and nonpulsatile proptosis. CHs can be asymptomatic until they reach a considerable size, but when lodged deep in the orbital apex, even small masses may cause severe functional deficits.² If found incidentally, a wait-and-scan policy is advised. Surgical treatment is indicated in patients with visual impairment or in cases of volumetric increase during the follow-up.³ Among the different surgical corridors to the orbital apex, in the last decade, the endoscopic-assisted approaches, both transpalpebral and endonasal, have emerged as minimally invasive and effective techniques in the skull base surgeon's armamentarium.⁴ If those lesions are located medially to the optic nerve, the endoscopic endonasal approaches (EEAs) offer several advantages compared with standard craniotomies or orbitotomies.^5,6 A 45-year-old woman was admitted to our hospital with symptoms of progressive right visual impairment for 10 months, with radiologic finding of an encapsulated small roundish lesion at the right orbital apex. The mass was completely removed by means of EEA with intraoperative use of a dedicated cryoprobe (Video 1). Histopathologic examination confirmed the CH. At follow-up, the patient experienced complete resolution of her symptoms, with no residues or relapses on magnetic resonance imaging. This case sheds light on the advantages of EEA with the assistance of a cryoprobe, including optimal visualization of the target, lack of external incision, no brain retraction, and short hospital stays.