title: Vascular Steal Syndrome, Optic Neuropathy, and Foreign Body Granuloma Reaction to Onyx-18 Embolization for Congenital Orbito-Facial Vascular Malformation.
abstract: A 34-year-old patient presented with a right orbito-facial mass since childhood, consistent with a congenital arteriovenous (AV) malformation. Prior to presentation, she had multiple incomplete surgical resections and embolizations with N-butyl acetyl acrylate and Onyx-18. The patient reported gradual, progressive vision loss shortly after Onyx-18 embolization. Five months after embolization, she presented with decreased vision, disfigurement and mechanical ptosis relating to a large subcutaneous mass affecting the medial right upper eyelid and forehead. Significant exam findings included a visual acuity of 20/400 (20/60 prior to embolization), an afferent pupillary defect, and optic disc pallor. MRI and angiography revealed a persistent AV malformation with feeders from the ophthalmic artery and an absent choroidal flush to the right eye. Pathology from surgical resection showed a significant foreign body giant cell reaction to the embolization material adjacent to the vessels. We suggest that an incomplete embolization with Onyx-18 may have caused vascular steal syndrome from the ophthalmic artery.
authors.affiliation: Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA.
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Yonkers
authors.affiliation: Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA.
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Liu
authors.affiliation: Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA.
authors.forename: Don S
authors.initials: DS
authors.lastname: Minckler
authors.affiliation: Gavin Herbert Eye Institute, University of California Irvine, Irvine, Calif., USA.
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Tao
keywords: Embolization; Ptosis; Vascular lesion