Cavernous venous malformation coexisting with spontaneous arteriovenous fistula of eyelid
Author: Nutchaya Sukon
Base Hospital / Institution: Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
ePoster presentation
Abstract ID: 25-334
Purpose
To illustrate a case of periorbital cavernous venous malformations (CVMs) with concomitant spontaneous arteriovenous fistula (AVF) treated with endovascular intervention followed by surgical excision.
Methods
An interventional case report
Results
A 55-year-old female with no history of prior trauma presented with a chronic, progressive, painless, pulsatile, enlarging mass and mechanical ptosis in her left upper eyelid. Ophthalmic examination revealed a well-defined, pulsatile, bluish mass with a palpable thrill in the left upper eyelid. Magnetic resonance imaging and magnetic resonance angiography of the brain and orbits demonstrated a vividly enhancing lesion, coexisting with a suspected arteriovenous fistula (AVF), located in the preseptal area of the left upper eyelid. Diagnostic cerebral angiography confirmed an AVF in the left upper eyelid. The patient was treated with transvenous embolization using coils and N-butyl cyanoacrylate (NBCA) glue, combined with transarterial NBCA glue embolization, followed by surgical excision. Histopathological findings were compatible with combined vascular malformations (CVMs) and AVF. The patient had favorable clinical and radiological outcomes without recurrence at the 9-month follow-up.
Conclusion
The concomitant presence of periorbital low-flow and high-flow vascular malformations is an exceptionally rare clinical entity. We report the first documented case of the coexistence of a cavernous venous malformation (CVM) and a spontaneous arteriovenous fistula (AVF) in the eyelid. In this case, we hypothesize that the mechanism of the spontaneous periorbital AVF may be related to local mechanical erosion of adjacent arteries caused by the periorbital CVM. A multidisciplinary team approach—comprising endovascular intervention by interventional radiologists followed by surgical excision performed by oculoplastic surgeons—is essential to achieve favorable clinical outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Bunyada | Putthirangsiwong | Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand |
| Weerawan | Choktaweesak | Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand |
| Surawan | Boonyakarnkul | Interventional Neuroradiology Division, Diagnostic and Therapeutic Radiology Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand |
| Oranan | Tritanon | Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand |
| Jariya | Waisayarat | Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand |
