Surgical management and postoperative outcomes of orbital cavernous malformations: A systematic literature review by the EANS skull base section

Surgical management and postoperative outcomes of orbital cavernous malformations: A systematic literature review by the EANS skull base section

Introduction: Orbital cavernous malformations (OCMs) are benign vascular lesions frequently associated with progressive proptosis and visual disturbances due to their slow growth and compression of adjacent structures. Multiple surgical approaches have been developed for their treatment, including m...

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Main Authors: Edoardo Agosti, Vittorio Ricciuti, Giorgio Mantovani, Giorgia De Rosa, Pier Paolo Panciani, Marco Maria Fontanella, Cesare Zoia, Moncef Berhouma, Michaël Bruneau, Luigi Maria Cavallo, Jan Frederick Cornelius, Sebastien Froelich, Emmanuel Jouanneau, Diego Mazzatenta, Torstein R. Meling, Mahmoud Messerer, Dimitris Paraskevopoulos, Pierre-Hugues Roche, HenryWS. Schroeder, Marcos Tatagiba, Idoya Zazpe, Roy Thomas Daniel
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:Brain and Spine
Subjects:
Cavernous malformations
Orbit
Systematic review
Surgical approaches
Outcomes
Online Access:http://www.sciencedirect.com/science/article/pii/S2772529425001213
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Summary:Introduction: Orbital cavernous malformations (OCMs) are benign vascular lesions frequently associated with progressive proptosis and visual disturbances due to their slow growth and compression of adjacent structures. Multiple surgical approaches have been developed for their treatment, including microsurgical transfacial-transorbital approaches (MTTAs), cranio-orbital approaches (MCOAs), orbitotomies (MOs), endoscopic endonasal approaches (EEAs), and endoscopic transorbital approaches (ETOAs). However, the optimal approach remains a topic of debate. Research objective: This systematic review aims to compare the resection rates, postoperative complications, and clinical outcomes across various surgical approaches for OCM management. Methods: A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library according to PRISMA guidelines. Studies reporting surgical treatment of OCMs with clinical outcome data were included. Study quality was assessed using the Newcastle-Ottawa Scale. Statistical analyses were conducted using chi-square and Mann-Whitney U tests. Results and conclusions: Of 239 screened studies, 94 met inclusion criteria, comprising 1007 patients (mean age 43.9 years; 58.5 % female). Proptosis (63.2 %) and visual impairment (48.1 %) were the most common symptoms. Most lesions were intraconal (80 %) and laterally positioned (42.8 %). EEAs were the most commonly used approach (40.1 %), followed by MOs (25.7 %) and MTTAs (21.6 %). Gross total resection was achieved in 93.7 % of cases. Complications were infrequent: visual acuity worsening (3.9 %), diplopia (2.4 %), and enophthalmos (1.7 %). Functional outcomes improved significantly, particularly visual acuity (65.1 %) and proptosis (61.6 %). EEAs provide high resection rates with minimal morbidity, especially for medial OCMs. ETOAs represent a promising, minimally invasive option for laterally located lesions.
ISSN:2772-5294

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