Orbital venous malformations: current multidisciplinary treatment approach

Area of Science:

• Ophthalmology
• Vascular Surgery
• Radiology

Background:

• Orbital venous flow malformations (OVMs) present diverse clinical, radiological, and histopathological features.
• Understanding these features is crucial for effective treatment planning.

Purpose of the Study:

• To evaluate OVMs' clinical, radiological, and histopathological characteristics.
• To assess treatment outcomes for OVMs.
• To propose a systematic treatment approach for OVMs.

Main Methods:

• Retrospective review of 22 patients with OVMs over 38 years.
• Analysis of clinical presentation, radiological findings, and treatment modalities.
• Evaluation of patient outcomes following various interventions.

Main Results:

• Eighteen of 22 patients had distensible OVMs, with earlier onset compared to nondistensible types.
• Deep, nondistensible OVMs presented with sudden proptosis, pain, or diplopia due to thrombosis/hemorrhage.
• Treatment success (complete resolution or marked improvement) was observed in 14/14 patients with follow-up, with varied techniques including laser ablation, sclerotherapy, embolization, and surgical excision.

Conclusions:

• Less invasive treatments like CO2 laser ablation and percutaneous alcohol sclerotherapy are recommended for superficial/combined OVMs.
• Endovascular embolization with Guglielmi detachable coils is suggested for deep orbital lesions.
• A systematic approach prioritizing less invasive methods is advised before considering extensive surgical procedures.