Low outflow distensible venous malformations of the anterior orbit: presentation, hemodynamic factors, and management.
OBJECTIVE
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.
Garcia
Denise D
DD
Department of Ophthalmology, University of Washington, Seattle, Washington, USA. Denisedgarciamd@gmail.com
Heran
Manraj K S
MK
Amadi
Arash J
AJ
Rootman
Jack
J
D000293:Adolescent; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D002648:Child; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000098:blood supply*; D010690:Phlebography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D014680:Veins
D014014:Tissue Adhesives; D004659:Enbucrilate