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Case series
Embolization of palpebral and orbito-frontal fistulas: technical and anatomical considerations in treating high-flow superficial skin lesions with liquid embolics
  1. Edgar A Samaniego1,
  2. Mark Fisher2,
  3. David Hasan3,
  4. Waldo R Guerrero1,
  5. Johanna T Fifi4,
  6. Laura Bottani5,
  7. Santiago Ortega-Gutierrez1
  1. 1Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa, USA
  2. 2Department of Plastic Surgery, University of Iowa, Iowa City, Iowa, USA
  3. 3Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
  4. 4Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
  5. 5Departamento de Neurocirugia, Hospital Eugenio Espejo, Quito, Ecuador
  1. Correspondence to Dr Edgar A Samaniego, Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa 52242, USA; edgarsama{at}


The treatment of palpebral and periorbital fistulas may be challenging due to the presence of multiple anastomosis with eloquent ophthalmic and intracranial vascular territories. Moreover, cosmetic and functional characteristics of this area pose unique challenges to open surgical approaches and endovascular therapy. We review the advantages and disadvantages of different liquid embolics in treating palpebral and periorbital fistulas as we describe three successfully treated cases. Moreover, we describe important anatomical landmarks that should be considered at the time of treatment of these lesions.

  • embolic
  • fistula
  • liquid embolic material

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  • Contributors EAS and SOG: acquisition of data, data analysis and manuscript preparation. EAS: study design, data analysis, manuscript preparation, critical revision of the manuscript and guarantor of the study. All authors reviewed and approved the manuscript.

  • Competing interests EAS is a consultant for Microvention. SOG is a consultant for Stryker. MF, DH, WRG, JTF and LB have nothing to disclose.

  • Patient consent Obtained.

  • Ethics approval IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Complete angiograms are available upon request.

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