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Kaneko N, Rootman DB, Takayanagi A, Goldberg R, Duckwiler GR, Tateshima S. Intermittent Orbital Pain due to Hemodynamic Collapse of an Orbital Varix: A Case Report. Case Rep Ophthalmol 2023; 14:353-357. [PMID: 37901639 PMCID: PMC10601828 DOI: 10.1159/000531601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 10/31/2023] Open
Abstract
Orbital varices typically present with symptoms related to dilation or thrombosis. We describe a rare presentation of an orbital varix with pain caused by hemodynamic collapse of the varix. A woman in the third decade presented with position-dependent orbital pain and enophthalmos. She was found to have an intraorbital varix and a separate pterygoid varix. The patient underwent endovascular treatment of the pterygoid varix using coils and sclerosing agents which altered the venous outflow from the orbital varix. The patient had immediate resolution of symptoms after the procedure. Our findings suggest that extraorbital venous outflow abnormalities may be the cause of symptoms in selected cases of orbital varices. By understanding the venous structures on cerebral angiography and treating the extraorbital component, orbital intervention may be avoided, reducing the risk of complications.
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Affiliation(s)
- Naoki Kaneko
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel B. Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, CA, USA
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, Los Angeles, CA, USA
| | - Ariel Takayanagi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, CA, USA
| | - Robert Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Gary R. Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Satoshi Tateshima
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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2
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Cohen LM, Goldberg RA, Rootman DB. Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision. Ophthalmic Plast Reconstr Surg 2021; 38:283-288. [PMID: 34798656 DOI: 10.1097/iop.0000000000002085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Treatment for orbital venolymphatic malformations (VLMs) commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. Each has certain advantages, although it is not clear whether all are effective. The authors characterize the clinical course for a series of patients with distensible orbital venous-dominant VLM treated with sclerotherapy and/or embolization with excision. METHODS In this cross-sectional cohort study, patients affected by distensible orbital venous-dominant VLM presenting to the orbital and ophthalmic plastic surgery service from 2014 to 2020 were identified. Patients were included if they presented with a moderate-flow, distensible venous-dominant malformation associated with Valsalva-related symptoms (e.g., pain, proptosis, and diplopia). RESULTS Six cases were treated with sclerotherapy. Four underwent multiple treatments, with a mean ± SD of 3.5 ± 2.3 (range 1-7). All patients in this group failed to improve or experienced recurrence of symptoms after sclerotherapy. Twelve cases were treated with embolization and excision. Resolution of symptoms in all 12 cases was noted and maintained for a mean of 3.4 ± 2.1 years. There have been no cases of recurrence. Patients treated with sclerotherapy were more likely to experience recurrence of symptoms compared to those treated with embolization and excision (p < 0.001). CONCLUSIONS Treatment of distensible venous-dominant moderate-flow orbital VLM with sclerotherapy may provide temporary improvement in some cases. However, in the medium to long term, recurrence was universal in this series. Embolization with excision appears to provide more definitive management, avoiding recurrence in all cases for a mean follow-up of 3 years.
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Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
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Xie M, Li T, Luo Y, Li Y, Wang Y, Fan X, Heindl LM, Jia R. Intralesional diode laser pretreatment facilitates surgery for orbital venous malformations: initial experience with 23 consecutive patients. Graefes Arch Clin Exp Ophthalmol 2021; 260:303-309. [PMID: 34379188 DOI: 10.1007/s00417-021-05272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to evaluate the efficacy and safety of intralesional diode laser pretreatment for facilitating surgery for orbital venous malformations (OVMs). METHODS This is a retrospective, non-comparative, interventional cohort involving 23 consecutive OVM patients undergoing intralesional laser pretreatment followed by surgical excision. The main outcome measures included volumetric changes, exophthalmometry, cosmesis, and symptom scores as well as treatment-related adverse events. RESULTS Following intralesional diode laser, the mean volume dropped significantly from 2366 ± 1887 to 129 ± 119 mm3 (t = 5.716; p < 0.001). After a single treatment session, a mean 90 ± 13% volume shrinkage was achieved in all 23 OVM. The mean Hertel exophthalmometry decreased significantly from 14 ± 3 to 13 ± 1 mm (t = 2.515; P < 0.02). The resolution of periocular dyschromasia and swelling were evident in 20 patients (87%). Symptom scores improved significantly from 6.5 ± 1.4 (very intense discomfort or effect on daily living) to 1.2 ± 1.0 (very mild discomfort or effect on daily living; p < 0.001). Short-term bruises and swelling were reported in 20 patients (87%). CONCLUSION Intralesional laser pretreatment is effective to facilitate surgery especially for the deep involving orbital venous malformations.
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Affiliation(s)
- Minyue Xie
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Tianyuan Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yinwei Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. .,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany.
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. .,Department of Ophthalmology, Ninth People's Hospital, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Jiao Tong University School of Medicine (SJTU-SM), Shanghai, 200025, China.
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5
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Classification and treatment of orbital venous malformations: an updated review. Front Med 2018; 13:547-555. [PMID: 30097960 DOI: 10.1007/s11684-018-0623-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022]
Abstract
Orbital venous malformation (OVM) is a congenital vascular disease. As a common type of vascular malformation in the orbit, OVM may result in vision deterioration and cosmetic defect. Classification of orbital vascular malformations, especially OVMs, is carried out on the basis of different categories, such as angiogenesis, hemodynamics, and locations. Management of OVM is complicated and challenging. Treatment approaches include sclerotherapy, laser therapy, embolization, surgical resection, and radiotherapy. A satisfactory outcome can be achieved only by selecting the appropriate treatment according to lesion characteristics and following the sequential multi-method treatment strategy. This article summarizes the current classification and treatment advances in OVM.
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Khanna RK, Le Lez ML, Precausta F, Pisella PJ, Cottier JP, Majzoub S. [Thrombosis of superior ophthalmic vein varix associated with contralateral superior ophthalmic vein varix in an 89-year-old woman]. J Fr Ophtalmol 2017; 40:e3-e5. [PMID: 28065462 DOI: 10.1016/j.jfo.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R K Khanna
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
| | - M-L Le Lez
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - F Precausta
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - P-J Pisella
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - J-P Cottier
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - S Majzoub
- Hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France
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Abstract
A 48-year-old man presented with a longstanding left upper eyelid mass that increased in size when bending forward. The mass was associated with enophthalmos and slowly increased in size with Valsalva maneuver. Magnetic resonance imaging and arteriography demonstrated a vascular malformation without an abnormal arterial component. Because of his increasing pain, the vascular malformation was excised in a multidisciplinary approach involving intraoperative fluoroscopic mapping, cyanoacrylate embolization, and surgical excision. Histopathology was consistent with a benign vascular malformation. Clinically, this was a low-flow, distensible venous malformation-or orbital varix.
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8
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Abstract
PURPOSE Orbital vascular malformations are classified by their hemodynamic properties, either high or low flow. Low-flow lesions may be simple venous, lymphatic, or combined lymphaticovenous malformations. The authors report a series of cases in which predominantly low flow, venous lesions were unexpectedly noted to have arterial feeders. METHODS A retrospective chart review of patients identified by the authors as having orbital varices with arterial components was conducted. The authors identified 7 such cases. After careful review, 2 cases were excluded due to inconclusive neuroradiographic findings. The authors review the clinical, radiologic, histopathologic, and surgical information from the remaining 5 cases and discuss their clinical significance. RESULTS All 5 cases were most consistent with variceal lesions: 3 as clinically distensible lesions and 2 as thrombosed lesions. Additional arterial feeder vessels were noted by angiography (3) or intraoperative visualization (2). The arterial contribution varied from faint vessels to distinct branches of the ophthalmic artery. Ages ranged from 13 to 61 years without predilection for gender. Treatments consisted of excision, embolization, and observation. Two poignant cases are highlighted: the first illustrating that an angiogram in isolation of its clinical picture can be misleading and result in treatment intervention with undue risk, and the second illustrating that inadequate treatment of unrecognized arterial components may contribute to recurrences. CONCLUSIONS Low-flow orbital variceal lesions may have less prominent, arterial components. This type of combined arterialized venous malformation is largely unrecognized in the ophthalmic literature. Correct identification of these lesions is critical in providing safe, effective, and durable treatment.
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Bracco S, Venturi C, Leonini S, Romano DG, Cioni S, Vallone IM, Gennari P, Galluzzi P, Hadjistilianou T, De Francesco S, Guglielmucci D, Tarantino F, Bertelli E. Identification of Intraorbital Arteries in Pediatric Age by High Resolution Superselective Angiography. Orbit 2015; 34:237-47. [PMID: 26154349 DOI: 10.3109/01676830.2015.1049368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Angiography is a powerful tool to identify intraorbital arteries. However, the incidence by which these vessels can be identified is unknown. Our purpose was to determine such incidence and which angiographic approach is best for the identification of each artery. METHODS A retrospective study of 353 angiographic procedures (via ophthalmic artery and/or external carotid artery) carried out on 79 children affected by intraocular retinoblastoma was made to investigate the arterial anatomy in 87 orbits. For each intraorbital artery two parameters were calculated: the angiographic incidence, as the percentage of times a given artery was identified, and the visibility index, as the ratio between the angiographic incidence and the true anatomic incidence. RESULTS All collaterals of the ophthalmic artery could be spotted. Most of them were identified with a high angiographic incidence; some of them were less easily identified because too thin or because frequently shielded. The visibility index paralleled the angiographic incidence of most arteries. However, the lacrimal and meningolacrimal arteries had a higher visibility index suggesting that their identification was more frequent than the angiographic incidence alone could suggest. Statistical analysis demonstrated that the lacrimal artery and some muscular branches had higher chances to be identified if the angiography of the ophthalmic artery was accompanied by the study of the external carotid system. CONCLUSION This work provides an objective measure of how powerful angiography is to identify intraorbital arteries as well as useful references for professionals who need to operate in the orbit.
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Affiliation(s)
- Sandra Bracco
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Carlo Venturi
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Sara Leonini
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Daniele G Romano
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Samuele Cioni
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Ignazio M Vallone
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Paola Gennari
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Paolo Galluzzi
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Theodora Hadjistilianou
- b Department of Medicine , Surgery and Neuroscience, Unit of Ophthalmology, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy .,c Referral Center for Retinoblastoma, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Sonia De Francesco
- c Referral Center for Retinoblastoma, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Daria Guglielmucci
- d Unit of Pediatrics , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Francesca Tarantino
- e Unit of Neurosurgical Intensive Care , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy , and
| | - Eugenio Bertelli
- f Department of Life Sciences , University of Siena , Siena , Italy
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Vadlamudi V, Gemmete JJ, Chaudhary N, Pandey AS, Kahana A. Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin. J Neurointerv Surg 2015; 8:e30. [PMID: 26122325 DOI: 10.1136/neurintsurg-2015-011777.rep] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/03/2022]
Abstract
An orbital venous varix is rare and can present with diplopia, proptosis, or hemorrhage. Treatment can be challenging, especially if the varix is in a posterior location within the orbit, since surgical exposure becomes difficult. A few case reports have been published describing transcatheter embolization of an orbital varix with coils, direct percutaneous injection of n-butyl cyanoacrylate glue, and the percutaneous injection of bleomycin. We present a case of a symptomatic orbital venous varix of the left inferior ophthalmic vein successfully treated with transvenous endovascular sclerotherapy using a microcatheter balloon and bleomycin.
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Affiliation(s)
- Venu Vadlamudi
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Alon Kahana
- Department of Ophthalmology and Visual Sciences, University of Michigan Health System, Ann Arbor, Michigan, USA
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11
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Vadlamudi V, Gemmete JJ, Chaudhary N, Pandey AS, Kahana A. Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin. BMJ Case Rep 2015; 2015:bcr-2015-011777. [PMID: 26109623 DOI: 10.1136/bcr-2015-011777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An orbital venous varix is rare and can present with diplopia, proptosis, or hemorrhage. Treatment can be challenging, especially if the varix is in a posterior location within the orbit, since surgical exposure becomes difficult. A few case reports have been published describing transcatheter embolization of an orbital varix with coils, direct percutaneous injection of n-butyl cyanoacrylate glue, and the percutaneous injection of bleomycin. We present a case of a symptomatic orbital venous varix of the left inferior ophthalmic vein successfully treated with transvenous endovascular sclerotherapy using a microcatheter balloon and bleomycin.
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Affiliation(s)
- Venu Vadlamudi
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Alon Kahana
- Department of Ophthalmology and Visual Sciences, University of Michigan Health System, Ann Arbor, Michigan, USA
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Kim JW, Lee KH, Park CK, Yoon JS. A Case of Surgical Management for Orbital Organizing Hematoma from Orbital Varix. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.10.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Won Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ka Hyun Lee
- Department of Ophthalmology, Konyang University College of Medicine, Seoul, Korea
| | - Cheol Keun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sook Yoon
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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