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Periorbital arteriovenous malformations: a word of caution
  1. Joseph J Gemmete
  1. Correspondence to Dr Joseph J Gemmete, Departments of Radiology and Neurosurgery, University of Michigan Hospitals, Ann Arbor, MI 48109, USA; gemmete{at}med.umich.edu

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Periorbital arteriovenous malformations (AVMs) are uncommon, locally aggressive lesions that pose a therapeutic challenge. The clinical presentation varies from asymptomatic, to tissue destruction, significant hemorrhage, or congestive heart failure. Endovascular treatment is challenging because the lesions are commonly fed by the ophthalmic artery and external carotid arteries, which may have communication to the ophthalmic artery, increasing the potential of vision loss in the event of non-target arterial embolization.1 Various surgical and endovascular methods have been described for the treatment of these lesions.2

The authors present a case series of three patients, describing their experience with the treatment of palpebral and orbito-frontal fistulas using three different types of liquid embolic agents: n-butyl cyanoacrylate (nBCA) (Codman Neurovascular, Raynham, Massachusetts, USA), ethylene vinyl alcohol (EVOH) (Onyx; Medtronic, Irvine, California, USA), and precipitating hydrophilic injectable liquid (PHIL) (Microvention, Tustin, California, USA).(.3 The authors describe intra-arterial injection of the three liquid embolic agents along with the percutaneous injection of nBCA and EVOH for the treatment of these lesions. Two of the patients subsequently underwent surgical excision of the lesion, one for redundant skin in the upper eyelid and the other to avoid a potential tattoo effect from the EVOH. Clinical follow-up, for the three patients, was 1 week, 6 months, and 14 months. The short term clinical outcomes for all three patients were excellent. However, given the natural history of AVMs with a high rate of recurrence after treatment. long term follow-up …

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