This is a review of six patients with cavernous venous malformations (haemangiomas) involving the orbital apex who were treated with fractionated stereotactic radiotherapy. Patients were diagnosed on MRI imaging with only one having had previous surgery to debulk the lesion. Indications for intervention included an afferent pupillary defect, proptosis, pain, visual field loss, reduced acuity and restricted eye movements. All patients received 45-50Gy in 25-28 fractions, with up to 52.5Gy to the optic nerve. Patients were followed up for a median of 74 months. All lesions shrank in volume, by an average of 64% after one year, and none regrew during the follow-up period. All patients had an improvement in their haemangioma-related signs and symptoms. There were no complications. A main concern would be the risk of radiation optic neuropathy, but the authors cite this risk at <3% for doses under 55Gy, and fractionated radiotherapy has less risk than single dose treatment. This is a small but convincing series advocating fractionated stereotactic radiotherapy for apical cavernous haemangiomas, which have a high risk of complications from attempted surgical removal.

Fractionated stereotactic radiotherapy for cavernous venous malformations of the orbital apex.
Ratnayake GS, McNab AA, Dally MJ, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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