Objective To evaluate the efficacy and selection criteria of different surgical approaches in patients with orbital cavernous hemangiomas.Methods It was a retrospective case series study,which included 164 patients with orbital cavernous hemangioma.The clinical and radiological characteristics of orbital cavernous hemangiomas were analyzed together with their surgical treatment and clinical outcomes.Results The following surgical procedures were used to treat the tumors:transconjunctival orbitotomy in 101 cases (61.6％) with roundish,well-defined intraconal masses;anterior orbitotomy in 25 cases (15.2％),in which all tumors were situated extraconally and superficially; lateral orbitotomy in 32 cases (19.5％) with intraconal masses,adhering tightly to retrobulbar tissue; combined lateral and medial orbitotomy in 5 cases (3.0％) with intraconal masses,adhering tightly to retrobulbar tissue,or located on both sides of the optic nerve; and medial orbitotomy in 1 case (0.6％) with an extraconal mass located medially.In 156 cases,the tumors were removed intact,and only 2 patients suffered permanent visual loss.In another 8 cases,fragments of the tumors were incompletely removed.Conclusion Orbital cavernous hemangiomas can be removed successfully with different surgical approaches.The choice and approach depends on the nature,location.and extension of the tumors.The surgical approach is based on adequate exposure and visualization,easy removal of the lesions and excellent cosmetic results.