Endoscopic Transorbital Resection of a Cavernous Sinus Hemangioma: A Minimally Invasive Solution for Visual Dysfunction

Background: Cavernous sinus hemangiomas (CSHs) are rare vascular malformations that challenge skull base surgeons due to their hypervascular nature and proximity to critical neurovascular structures. The endoscopic transorbital approach (ETOA) has emerged as a minimally invasive route to access the lateral cavernous sinus, potentially reducing morbidity compared to traditional transcranial approaches. We treated successfully CSHs with decreased visual acuity through ETOA. Case Description: A 44-year-old male presented with progressive visual acuity decline and visual field defect in the left eye. MRI revealed a 1.5 cm, well-enhancing lesion beneath the anterior clinoid process, compressing the left optic nerve and abutting the lateral rectus muscle. Fig. 1 Preoperative image The lesion was radiologically suspected of meningioma, schwannoma and hemangioma. A fully endoscopic transorbital approach via an infra-eyebrow incision was performed. Intraoperative navigation allowed precise localization. The mass appeared firm, red, hypervascular, and well demarcated. En bloc resection was carried out. Hemostasis was achieved using bipolar cautery and hemostatic agents. Gross-total resection was completed without compromising the optic nerve or extraocular muscles. Fig. 2 Intraoperative findings The patient showed significant postoperative improvement in visual function without any new neurological deficits. Fig. 3 Postoperative image and visual field test Conclusion: This case illustrates the feasibility and effectiveness of ETOA using an infra-eyebrow incision for the treatment of a cavernous sinus hemangioma causing visual symptoms. The approach provides direct and cosmetically favorable access to the lateral cavernous sinus with minimal disruption to surrounding structures. ETOA may serve as a valuable alternative to traditional skull base approaches in selected cases. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany