Orbital congestion complicating treatment of cerebral vascular anomalies.
BACKGROUND
The decision between conservative management and invasive treatment of juxtaorbital intracranial vascular anomalies can be challenging. Whereas arteriovenous malformations (AVMs) can lead to vision loss and are potentially life-threatening if they rupture, invasive endovascular and surgical procedures also carry risks.


METHODS
Two patients developed blinding orbital congestion soon after they were treated successfully for cerebral vascular anomalies. The first patient, a 36 year-old man, underwent partial embolization followed by resection of a congenital frontal-lobe AVM. The second patient, a 62 year-old woman, underwent embolization of a periorbital/skull base dural arteriovenous malformation. After intervention, both patients developed unilateral vision loss proptosis, chemosis, complete ophthalmoplegia, and increased intraocular pressure. The first patient suffered from acute orbital compartment syndrome in the absence of any acute localized hemorrhage or thrombosis. The second patient experienced refractory acute glaucoma from orbital congestion, secondary hyphema, and angle closure caused by superior ophthalmic vein and cavernous sinus thromboses.


CONCLUSIONS
These cases highlight the potential for orbital congestion to worsen acutely after invasive treatment of juxtaorbital cerebral vascular anomalies and suggest diverse mechanisms of resultant visual and orbital compromise. The first case represents the first report of orbital compartment syndrome after resection of a congenital AVM.
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: marc.levin@uphs.upenn.edu.
Marc H
MH
Levin
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Heather E
HE
Moss
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Stacy L
SL
Pineles
Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Linda J
LJ
Bagley
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Gregory G
GG
Heuer
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Eric L
EL
Zager
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Laura J
LJ
Balcer
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Steven L
SL
Galetta
Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
M Reza
MR
Vagefi
D000328:Adult; D001766:Blindness / Q000209:etiology; D002533:Cerebral Angiography; D003399:Craniotomy; D004322:Drainage; D004621:Embolization, Therapeutic; D005260:Female; D005901:Glaucoma / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015835:Ocular Motility Disorders / Q000209:etiology / Q000628:therapy; D009901:Optic Nerve Diseases / Q000150:complications; D009915:Orbit / Q000473:pathology*; D016896:Treatment Outcome; D014792:Visual Acuity
Arteriovenous malformation; Dural arteriovenous fistula; Orbital compartment syndrome