Embolization of palpebral and orbito-frontal fistulas: technical and anatomical considerations in treating high-flow superficial skin lesions with liquid embolics

Abstract

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.

Periorbital Inner Canthal Arteriovenous Malformations: Percutaneous Glue Embolization in Three Cases

“…6 It is sometimes difficult to gain distal access and perform superselective embolization of feeders particularly the ophthalmic artery. 7 Apart from the risk of incomplete embolization and retained microcatheter tip with transarterial embolization, 3 inadvertent embolization or reflux of embolic agent into the central retinal artery can lead to severe visual deficits. 8 Percutaneous approach to embolization of these lesions has proved to be equally efficacious and safe with immediate obliteration of vascularity and relief of symptoms.…”

“…1 AVMs of the eyelid and canthus are uncommon with only few isolated case reports and small case series. [2][3][4][5] Endovascular treatment of these highly vascular lesions prior to surgical removal by selective embolization of the arterial feeders has been documented. 3 However, endovascular embolization in lid lesions is technically challenging, due to the complex nature of the arterial supply of the orbit and its adnexa with its rich anastomoses.…”

“…[2][3][4][5] Endovascular treatment of these highly vascular lesions prior to surgical removal by selective embolization of the arterial feeders has been documented. 3 However, endovascular embolization in lid lesions is technically challenging, due to the complex nature of the arterial supply of the orbit and its adnexa with its rich anastomoses. 6 Percutaneous direct puncture of the nidus and venous pouch is a more efficient alternative to transarterial embolization in these superficial lesions.…”

Ethmoidal dural arteriovenous fistulas: endovascular transvenous embolization technique

“…However, they may have angiographic features that increase the risk of rupture: cortical venous drainage, venous ectasia, venous stenosis and high arterial flow. If the dAVF has these angiographic features, treatment may be indicated regardless of the clinical presentation 2–4. In this neurosurgical endovascular video 1, we present two patients with high-flow ethmoidal dAVFs treated via transvenous endovascular approaches.…”

Periorbital arteriovenous malformations: a word of caution

“…( 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.…”