Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision

Cohen, Liza M.; Goldberg, Robert A.; Rootman, Daniel B.

doi:10.1097/iop.0000000000002085

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…Typical management with either sclerotherapy or embolization and excision are both designed to stabilize the baseline (non-Valsalva augmented) state. 5,7 In patients with significant baseline enophthalmos this will, by design, leave the patient volume depleted. In some cases, there may be a role for leaving the glued lesion in situ.…”

Section: Discussionmentioning

confidence: 99%

“…This emphasis accounts for the complexity in the presentation and can be useful in guiding management. 5 Whatever the tissue composition may be, the hemodynamic properties of orbital VMs play a critical role in identifying an appropriate management plan. 6,7 On the venous side, distensibility takes on a more central role in the orbit, as it is a nonexpansible space with a single outlet.…”

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confidence: 99%

“…This emphasis accounts for the complexity in the presentation and can be useful in guiding management. 5…”

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confidence: 99%

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Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva

Cheng

Roelofs

Pirakitikulr

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Determining the hemodynamic characteristics of an orbital vascular malformation is a critical step in management. The purpose of this study is to assess the relationship between enophthalmos and clinically apparent distensibility of orbital vascular malformations, to optimize imaging and treatment.Methods: In this cross-sectional cohort study consecutive patients at a single institution were screened for study entry. Data extracted included age, sex, Hertel measurements, presence or absence of distensibility during the Valsalva maneuver, whether lesions were primarily venous or lymphatic based on imaging, and location of the lesion relative to the globe. Enophthalmos was defined as ≥ 2 mm difference from the opposite side. Parametric and nonparametric statistics were used, and linear regression was performed to examine factors predictive of Hertel measurement.Results: Twenty-nine patients met the inclusion criteria. Relative enophthalmos ≥2 mm was significantly associated with distensibility (p = 0.03; odds ratio = 5.33). Distensibility and venous dominant morphology were the 2 most important factors associated with enophthalmos on regression analysis. The relative position of the lesion anterior or posterior to the globe did not have a significant bearing on baseline enophthalmos.Conclusions: The presence of enophthalmos increases the likelihood that an orbital vascular malformation is distensible. This group of patients was also more likely to be characterized by venous dominant malformations. Baseline clinical enophthalmos may serve as a useful surrogate marker for distensibility and venous dominance, which may be useful in guiding the selection of appropriate imaging.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva

Cheng

Roelofs

Pirakitikulr

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Sclerotherapy with intralesional injection of sclerosants, including ethanol, morrhuate sodium, sodium tetradecyl sulfate, OK-432 (Picibanil), doxycycline, tetracyclines, bleomycin, or pingyangmycin, is a minimally invasive and effective treatment for orbital venous malformations. 16 , 17 , 20 Nonetheless, a direct puncture with contrast injection under fluoroscopic imaging guidance is typically required to confirm both the needle location within the lesion and the flow characteristics. 1 Furthermore, all sclerosing agents cause direct endothelial injury with resultant thrombosis and fibrotic obliteration of the vascular lumen, with the exception of OK-432, which induces inflammation via cytokine release to achieve the same objective.…”

Section: Discussionmentioning

confidence: 99%

Acute unilateral orbital varix thrombosis in preexisting bilateral orbital varices: illustrative case

Pichayawat,

Chokthaweesak,

Leelawongs

et al. 2023

Journal of Neurosurgery: Case Lessons

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OBJECTIVE Orbital varix is a rare distensible orbital venous malformation. Most patients present with unilateral intermittent periorbital pain and positional proptosis that is exacerbated by the Valsalva maneuver. Complications include hemorrhage and thrombosis, leading to sudden painful proptosis and visual disturbance. OBSERVATIONS A 42-year-old female with a history of bilateral intermittent painless proptosis that was accentuated by a postural head-down position presented with acute painful proptosis in her right eye. Ophthalmic examination revealed right eye proptosis with a bluish mass at the right upper eyelid, and another bluish mass at the left lower eyelid that was prominent during the Valsalva maneuver. Computed tomography scans of the orbits indicated right orbital varix thrombosis and left orbital varix. Surgical excision of the right thrombosed varix was performed along with intralesional bleomycin injection in the left orbital varix. Histopathological examination confirmed the right thrombosed varix diagnosis. The patient had good clinical improvement at the 6-month follow-up. LESSONS Orbital varices have a spectrum of clinical manifestations, from asymptomatic to severe visual loss. Most cases are successfully treated conservatively; however, in complicated cases, interventions with a multidisciplinary team approach such as sclerotherapy, embolization, and surgical excision should be considered.

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“…As OVLM lesions are often poorly demarcated, complete gross resection is challenging and there is thus a high recurrence rate after attempted primary resection 3. Recent literature has demonstrated that sclerotherapy may be ineffective for patients with distensible, venous-dominant moderate-flow OVLM due to frequent recurrence 4. OVLM recurrence rates as high as 23% postsclerotherapy and 58% postsurgical resection have been reported 5,6…”

Section: Discussionmentioning

confidence: 99%

Glue Embolization Without Surgical Resection for Orbital Venolymphatic Malformation

Saffari

Rootman

Karlin

2022

Journal of Craniofacial Surgery

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We thought that mucocele was most likely based on the imaging findings, and endoscopic sinus surgery was planned to remove it. When right sphenoidotomy was performed, a mass was found in the sphenoid sinus. A polypoidal capsule surrounded the mass, and fluid and fibrous tissue were present inside the mass (Fig. 2A). No evidence of the involvement of the superior and posterior wall of the sphenoid sinus, sella turcica, and dura mater was found. The pathologic findings indicated that the epithelial cells resemble ameloblastoma with peripheral palisading cells and central wet keratins (Fig. 2B). This finding is consistent with the pathologic findings on craniopharyngioma. No remarkable complications after surgery and recurrence after more than 5 years of follow-up were observed.

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Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision

Cited by 3 publications

References 23 publications

Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva

Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva

Acute unilateral orbital varix thrombosis in preexisting bilateral orbital varices: illustrative case

Glue Embolization Without Surgical Resection for Orbital Venolymphatic Malformation

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