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Preoperative Ultrasound-Guided Percutaneous Embolization of Orbital Lymphaticovenous Malformations Using Onyx
Kareem El Naamani1, Jacqueline Carrasco2, Sathyadeepak Ramesh3
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Abstract:
The treatment of orbital lymphaticovenous malformations (OLVMs) has evolved from simple surgical resection to a multimodal approach consisting of sclerosing agents, embolization, and resection depending on the specific components that compose the lesion. Here we present a representative case series of 5 nonconsecutive patients who underwent percutaneous embolization of OLVMs with the Onyx Liquid Embolic System (Medtronic, Dublin, Ireland) before surgical resection between 2019 and 2021. OLVMs are rare, benign, congenital lesions that grow with age and can become symptomatic and disabling. Treatment can be conservative or invasive; depending on the clinical presentation and characteristics of the lesions, treatment modalities can vary. Preoperative percutaneous embolization of OLVMs with the Onyx system is a promising technique, as demonstrated in this case series.
Insights
Orbital lymphaticovenous malformations (OLVMs) were treated with Onyx embolization before surgery. This multimodal approach shows promise for managing these rare, congenital orbital lesions.
Area of Science:
- Ophthalmology
- Vascular Surgery
- Interventional Radiology
Background:
- Orbital lymphaticovenous malformations (OLVMs) are rare, congenital vascular anomalies.
- Traditional treatment involved surgical resection, often with suboptimal outcomes.
- A multimodal approach integrating sclerosing agents, embolization, and resection is now preferred.
Observation:
- A case series of 5 patients with OLVMs treated between 2019 and 2021.
- All patients underwent percutaneous embolization using the Onyx Liquid Embolic System prior to surgical resection.
- The Onyx system was utilized for preoperative embolization.
Findings:
- Preoperative embolization with the Onyx system was successfully performed in all cases.
- This technique facilitated subsequent surgical resection of OLVMs.
- The case series demonstrates the feasibility and potential benefit of this approach.
Implications:
- Percutaneous embolization with Onyx represents a promising preoperative strategy for OLVMs.
- This multimodal technique may improve surgical outcomes and reduce patient morbidity.
- Further research is warranted to establish the long-term efficacy of this treatment paradigm.
