Treatment of deep vascular orbital malformations

In this article, we discuss the clinical features and endovascular and/or surgical treatment of deep vascular orbital malformations.

We report on our treatment of 58 cases of vascular malformations of the orbit between 1991 and 2008.

Arterial low flow lesions, such as cavernomas (n=44) were the most common finding. These were treated by complete excision. High flow lesions such as angiomas were less common (n=4). These were treated by the endovascular and/or surgical approach. Venous flow lesions appear as distensible lesions (n=3) or non-distensible anomalies (n=4). Deep venous lesions (n=7) should be treated if they cause severe pain, progressive proptosis, motility disturbances or visual deterioration. No flow lesions include lymphangiomas (n=3). Surgery may be helpful in specific cases with intracystic haemorrhage and progressive proptosis. Patients with severe visual deterioration do not improve, whereas all other symptoms are potentially reversible.

Treatment of vascular malformations is required in case of progression of symptoms. In cases of visual deterioration, we generally favour early treatment. The least invasive surgical approach, tailored to the individual patient, should be chosen.