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Low Outflow Distensible Venous Malformations of the Anterior Orbit: Presentation, Hemodynamic Factors, and Management

Garcia, Denise D. M.D.*; Heran, Manraj K. S. M.D.; Amadi, Arash J. M.D.*; Rootman, Jack M.D.‡§

Ophthalmic Plastic & Reconstructive Surgery: January-February 2011 - Volume 27 - Issue 1 - p 38-43
doi: 10.1097/IOP.0b013e3181dc8338
Original Investigations
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Purpose: To describe a subclass of venous malformations of the orbit whose hemodynamic properties make them ideal for treatment with the technique of intraoperative embolization using cyanoacrylate glue followed by direct surgical excision.

Methods: A retrospective, noncomparative clinical study of 3 patients with “low-outflow” venous lesions of the anterior orbit who underwent treatment with the above technique in January 2008 and were followed for 2 years.

Results: Three patients presented with venous malformations of the orbit and elected to undergo surgical intervention. All cases demonstrated clinical and/or radiographic evidence of slow distensibility and were characterized by limited outflow through one or a few draining veins. All underwent intraoperative embolization using cyanoacrylate glue followed by direct surgical excision. In all cases, the surgical dissection of the lesion postgluing was straightforward. The boundary between the lesion and surrounding normal tissues was well demarcated, meticulous hemostasis was easy to maintain, and complete surgical excision was achieved. All 3 patients are doing well after 2 years with no recurrence of their lesions.

Conclusions: “Low-outflow” venous lesions of the orbit can be safely treated with intraoperative embolization using cyanoacrylate glue followed by direct surgical excision, thereby ensuring complete removal of the lesion and minimizing chances of recurrence.

Distensible venous malformations of the orbit with limited outflow through one or a few draining veins are ideal lesions to be treated with intraoperative embolization using cyanoacrylate glue followed by direct surgical excision.

*Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A.; Departments of †Radiology, ‡Ophthalmology and Visual Sciences, and §Pathology and Laboratory Medicine, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada

Accepted for publication March 7, 2010.

Presented as a poster at the 2nd Annual Orbital Society Symposium in New York, U.S.A., September 2008.

The authors declare no conflict of interest.

Address correspondence and reprint requests to Denise D. Garcia, M.D., 1055 S. Stapley Dr., Mesa, AZ 85204, U.S.A. E-mail: Denisedgarciamd@gmail.com

©2011The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.