Comparative outcomes of cryoextraction and conventional extraction in anterior and lateral orbitotomy for orbital cavernous venous malformations (so-called cavernous hemangioma)

Abstract

Comparison of surgical outcomes of lateral orbitotomy and transconjunctival anterior orbitotomy using the swinging eyelid approach for cavernous venous malformations (CVM), with and without cryoextraction. In this single-center, retrospective case series (2005–2024), a single surgeon performed CVM excisions. Operative time and postoperative complications were compared across surgical approaches and extraction techniques for a cohort of 60 patients. Lateral orbitotomy was performed in 25 patients (14 conventional, 11 cryo-assisted) and the swinging eyelid approach in 35 patients (16 conventional, 19 cryo-assisted). In the swinging eyelid group, cryoextraction significantly reduced operative time (49.0 vs. 59.0 min, p = 0.04). A similar trend was observed in the lateral orbitotomy group, although the difference was not statistically significant (81.0 vs. 101.5 min, p = 0.23). Postoperatively, visual acuity remained stable or improved in 97% of patients. Diplopia occurred less frequently following cryo-assisted extraction and was transient in most cases, with persistent diplopia requiring further intervention occurring exclusively after conventional extraction. Cryoextraction is associated with shorter operative times and favorable functional outcomes in the surgical management of orbital cavernous venous malformations, particularly when using the swinging eyelid approach. When applied in appropriately selected cases, cryoextraction represents a safe and effective technique that may reduce surgical manipulation and postoperative morbidity.