• Surgical management and postoperative outcomes of orbital cavernous malformations: A systematic literature review by the EANS skull base section
• Orbital angioleiomyoma with GJA4 mutation mimicking cavernous venous malformation: a case report and comprehensive review
• The Hidden Berry, a Vascular Mystery: Unveiling a Comparison Between Two Cases of Orbital Cavernous Venous Malformation (OCVM)
• Contrast-enhanced ultrasound characteristics in orbital cavernous venous malformation
• A Rare and Complex Diagnostic Challenge: Herpes Zoster Ophthalmicus With Secondary Orbital Apex Syndrome in a 65-Year-Old Male
• Surgical treatment of orbitocranial and orbital cavernous venous malformations (ophthalmological aspects)
• Endoscopic endonasal surgery for ORBIT stage orbital cavernous hemangioma: a preliminary experience of 20 cases
• Carotid cavernous fistula complicated by contralateral abducens palsy and optic neuropathy

In a systematic review Agosti et al. from the University of Brescia, published in Brain Spine to evaluate surgical outcomes, complication rates, and optimal approaches for orbital cavernous malformations (OCMs) via a systematic literature review. Endoscopic endonasal approaches (EEAs) dominate current practice with high gross total resection (GTR) rates (93.7%) and low complication rates. EEAs excel for medially located OCMs, while endoscopic transorbital approaches (ETOAs) show promise for lateral lesions. Visual and proptosis outcomes significantly improved postoperatively ¹⁾.

This systematic review presents a broad and well-curated aggregation of data regarding surgical management of OCMs, featuring 94 studies and over 1000 patients. The authors follow PRISMA guidelines and utilize appropriate databases and quality assessment tools, including the Newcastle-Ottawa Scale.

Strengths: - Cohort size (1007 patients) offers statistical power. - Surgical categorization and outcomes are clearly delineated. - Reported complication rates and functional outcomes provide tangible clinical relevance.

Weaknesses: - The heterogeneity of included studies (varying surgical techniques, institutional expertise, and reporting standards) severely limits the strength of aggregated conclusions. - No meta-analysis or quantitative synthesis to weigh the comparative efficacy of approaches. - Potential publication bias is not addressed. - The reliance on retrospective case series diminishes the overall evidence level (class IV).

Final Verdict: Methodologically competent but constrained by the inherent limitations of a review of retrospective studies. Conclusions are cautiously applicable but require validation by prospective comparative trials.

Takeaway for the Practicing Neurosurgeon: While EEAs appear advantageous for medial OCMs, approach selection must remain tailored to lesion location and surgeon expertise. The promise of ETOAs is intriguing but not yet definitively superior.

Bottom Line: A well-conducted yet fundamentally limited systematic review that affirms current trends and suggests directions rather than dictates them.

Rating: 6.5 / 10

Full Citation: Agosti E, Ricciuti V, Mantovani G, De Rosa G, Panciani PP, Fontanella MM, Zoia C; EANS Skull Base Section. Surgical management and postoperative outcomes of orbital cavernous malformations: A systematic literature review by the EANS skull base section. *Brain Spine.* 2025 Jun 22;5:104302. doi: 10.1016/j.bas.2025.104302. eCollection 2025.

Publication Date: 2025-06-22

Categories: Orbital Tumors, Skull Base Surgery, Systematic Reviews

Tags: orbital cavernous malformations, EANS, endoscopic approaches, skull base, neurosurgery, systematic review, visual outcomes, proptosis, surgical complications