Cavernous Hemangioma, Presumed To Be Orbital Scwannoma: Diagnostic Challenge And Successful Surgical Management

Abstract

Objectives:

Orbital tumors represent a heterogeneous group of lesions that can mimic one another clinically and radiologically. Cavernous venous malformation, schwannoma, and optic nerve sheath meningioma are among the most common benign orbital masses in adults. These tumors may lead to compressive optic neuropathy, resulting in progressive visual loss. We present a case of a longstanding orbital mass with compressive optic neuropathy in which surgical excision restored visual function.

Methods:

A 52-year-old woman presented with a four-year history of progressive left eyelid protrusion and gradual decline in visual acuity. Clinical evaluation demonstrated visual acuity of 6/19 in the right eye and 1/60 in the left eye, with a relative afferent pupillary defect and optic disc pallor. Magnetic resonance imaging of the orbit revealed a solid, well-circumscribed intraconal mass in the left orbit measuring 2.79 × 2.35 × 2.16 cm. The differential diagnoses included optic nerve sheath meningioma, cavernous venous malformation, and schwannoma.

Results:

The patient underwent surgical excision of the orbital tumor using a transconjunctival inferomedial orbitotomy with cryoprobe assistance. Intraoperatively, a well-encapsulated purplish mass was identified, extending to the orbital apex and compressing the optic nerve. The mass was successfully excised in toto with an intact capsule. Postoperative recovery was uneventful, and visual improvement was observed.

Conclusion:

This case underscores the diagnostic challenges of orbital tumors and emphasizes that surgical intervention remains critical in the setting of compressive optic neuropathy. Even in longstanding lesions, complete excision can restore visual function and prevent further irreversible damage..