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To investigate the feasibility, efficacy, and safety of an endoscopic transethmoidal‐sphenoidal approach in removing a small cavernous hemangioma (CH) located in the deep lateral orbital apex. All tumors in this study were completely removed. The mean BCVA was LogMAR 0.97 ± 0.97 preoperatively and LogMAR 0.38 ± 0.64 postoperatively (p < 0.05). The mean visual field index was 52.26% ± 33.26% preoperatively and 75.47% ± 30.49% postoperatively (p < 0.05). The mean deviation index was −17.48 ± 12.43 dB preoperatively and −10.10 ± 10.85 dB postoperatively (p < 0.05), and the pattern standard deviation was 6.37 ± 3.77 dB preoperatively and 4.90 ± 3.56 dB postoperatively (p > 0.05). Four (21.1%) patients developed oculomotor limitations and two (10.5%) patients developed ptosis after surgery. All of these symptoms resolved spontaneously, and no other complications occurred. The mean follow‐up time was 6.71 ± 3.89 months. The endoscopic transethmoidal‐sphenoidal approach is an effective and minimally invasive treatment for removing small CH in the deep lateral orbital apex.
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