Multimodal Management of an Orbital Venous-Lymphatic Malformation in a Pediatric Patient
Author: Antonio Florido
Base Hospital / Institution: University of Calgary
ePoster presentation
Abstract ID: 25-396
Purpose
To present a successful multimodal approach combining embolization and surgical resection in the management of a rapidly enlarging orbital venous-lymphatic malformation (VLM) in a pediatric patient, highlighting the safety and efficacy of intraoperative embolization in reducing surgical morbidity.
Methods
A 4-year-old male presented with acute right eye proptosis over two weeks. Examination revealed 6 mm axial proptosis, RONH edema, and restricted supraduction. MRI (image 1) demonstrated a 3.6 × 2.0 × 2.7 cm multiloculated, cystic intraconal mass consistent with a VLM, exerting mass effect on the optic nerve and adjacent muscles. A preoperative cerebral angiogram (image 2) confirmed the lesion’s low-flow nature. Surgical excision was planned via upper eyelid crease approach. Intraoperatively, Onyx embolization was performed under fluoroscopic guidance (image 3) to reduce bleeding. Controlled debulking was then achieved while preserving critical orbital structures.
Results
Onyx embolization provided excellent intraoperative visualization and significantly reduced bleeding. The lesion was found to be macrocystic with multiple internal compartments and was partially excised with preservation of orbital function. Postoperative recovery was uncomplicated. At 6-month follow-up, the patient remained asymptomatic, with full extraocular motility, resolution of proptosis, and no evidence of recurrence or vision loss.
Conclusion
Multimodal management of complex orbital VLMs with embolization and targeted resection is both safe and effective. Intraoperative embolization enhances surgical precision, minimizes intraoperative risks, and may improve long-term outcomes in pediatric patients with symptomatic lesions.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Charlotte | Lussier | University of Calgary |
| Ayman | Alghamdi | University of Calgary |
| Alim | Mittha | University of Calgary |
| Muneer | Eesa | University of Calgary |
| Karim | Punja | University of Calgary |
