Abstract ID: 26-161
Orbital Vascular Malformations: A Tertiary Centre Experience of Multidisciplinary Management
Author: Rithvik Mahadev Narendranath Base Hospital / Institution: Imperial College London, School of Medicine, UK
Presentation Type: ePoster Presentation
Purpose
To describe the clinical presentation, management and outcomes of patients with orbital vascular malformations.
Methods
A retrospective review of patients with orbital vascular malformations presenting to Imperial College Healthcare NHS Trust over a 2-year period. Data was extracted from electronic medical records and multidisciplinary team (MDT) documents, including patient demographics, presenting symptoms, MDT consensus diagnosis, primary treatment modality, and clinical outcomes.
Results
Seventeen patients were identified (mean age 51.0 years; 53% female; mean follow-up 17.5 months). Treatment varied significantly based on lesion haemodynamics. Three patients presented with spontaneous, indirect carotico-cavernous fistulas (CCFs) – 2 failed primary transvenous embolisation with 1 subsequently requiring craniotomy with direct closure, while the other spontaneously resolved. The third patient had successful transvenous embolisation but was complicated by central retinal vein occlusion. One CCF patient was initially misdiagnosed with thyroid eye disease and received immunomodulation before CCF confirmation. Pulsatile proptosis was absent in all cases. Fourteen patients presented with low-flow lesions, including cavernous haemangiomas, lid haemangiomas and arteriovenous malformations; 4 (28.6%) were incidental findings and 13 (92.9%) were managed conservatively with observation. One patient with an orbital varix presented acutely with orbital compartment syndrome requiring emergency lateral canthotomy and cantholysis.
Conclusion
Management of orbital vascular malformations is highly dependent on flow dynamics. While non-CCF low-flow lesions are predominantly managed safely with conservative observation, CCFs present therapeutic challenges with significant rates of primary endovascular failure and sight-threatening complications. Indirect CCFs are diagnostically challenging due to non-specific presentation and potential for misdiagnosis. MDT input is therefore essential for accurate diagnosis, treatment planning and management of acute complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Vincent | Ng | Imperial College Healthcare NHS Trust |
| Anshul | Radotra | Imperial College Healthcare NHS Trust |
| Mohammud | Musleh | Imperial College Healthcare NHS Trust |
| Vickie | Lee | Imperial College Healthcare NHS Trust |