Distensible venous malformations of the orbit

Multifocal cavernous hemangioma: A rare presentation

“…Further, if the patient performs the Valsalva maneuver during these imaging techniques, the hemodynamic characteristics of these lesions become markedly apparent. 1,13 Cavernous hemangiomas of the temporalis muscle, temporal fossa and cheek usually lead to merely a cosmetic deformity, as was also evident in this case. 5,7,8 Surgical intervention may not be required unless these tumors result in major disfugurement or produce a functional deficit.…”

“…These lesions may involve the periorbital skin, orbit, extraorbital sites (central nervous system, nasal sinuses or elsewhere), or a combination of these sites. 1,[3][4][5][6][7][8][9]12,13 In a case series by Katz et al, 12 it was found that lymphangiomas also may show similar diffuse, multifocal involvement of the orbit, soft tissues of the face including the forehead, and palate. True varices may be clinically distinguished from cavernous hemangiomas as they have distinctive hemodynamic characteristics, i.e.…”

“…distensibility on Valsalva maneuver due to its communication with the systemic venous system. 13 Venography, CT-scan and/or MRI with contrast enhancement and MRI angiography help in demonstrating the contour, extent and communication of the lesions with each other and the systemic vascular channels. Further, if the patient performs the Valsalva maneuver during these imaging techniques, the hemodynamic characteristics of these lesions become markedly apparent.…”

“…Deep or superficial excision of the lesion may be facilitated by the use of thrombosing agents, ligation and clipping of the abnormal vessels, and the carbon dioxide laser which helps in hemostasis. 13,14 Recently, a few authors have found intraoperative direct venography for vascular isolation, followed by embolization with cyanoacrylate glue, to be of great help in facilitating the excision of distensible venous malformations of the orbit.A direct-puncture sclerosing procedure is an effective method for controlling some facial venous malformations. 13 In conclusion, cavernous hemangioma involving a multitude of sites, as seen in this case, is indeed a rare presentation.…”

“…13,14 Recently, a few authors have found intraoperative direct venography for vascular isolation, followed by embolization with cyanoacrylate glue, to be of great help in facilitating the excision of distensible venous malformations of the orbit.A direct-puncture sclerosing procedure is an effective method for controlling some facial venous malformations. 13 In conclusion, cavernous hemangioma involving a multitude of sites, as seen in this case, is indeed a rare presentation. Clinical parameters and appropriate imaging techniques are employed to differentiate this entity from other vascular and lymphatic malformations.…”