Evaluation and endovascular treatment of juxtaorbital vascular anomalies

Orbital congestion complicating treatment of cerebral vascular anomalies

BACKGROUND

The decision between conservative management and invasive treatment of juxtaorbital intracranial vascular anomalies can be challenging. Whereas arteriovenous malformations (AVMs) can lead to vision loss and are potentially life-threatening if they rupture, invasive endovascular and surgical procedures also carry risks.

CASE DESCRIPTIONS

Two patients developed blinding orbital congestion soon after they were treated successfully for cerebral vascular anomalies. The first patient, a 36 year-old man, underwent partial embolization followed by resection of a congenital frontal-lobe AVM. The second patient, a 62 year-old woman, underwent embolization of a periorbital/skull base dural arteriovenous malformation. After intervention, both patients developed unilateral vision loss proptosis, chemosis, complete ophthalmoplegia, and increased intraocular pressure. The first patient suffered from acute orbital compartment syndrome in the absence of any acute localized hemorrhage or thrombosis. The second patient experienced refractory acute glaucoma from orbital congestion, secondary hyphema, and angle closure caused by superior ophthalmic vein and cavernous sinus thromboses.

CONCLUSIONS

These cases highlight the potential for orbital congestion to worsen acutely after invasive treatment of juxtaorbital cerebral vascular anomalies and suggest diverse mechanisms of resultant visual and orbital compromise. The first case represents the first report of orbital compartment syndrome after resection of a congenital AVM.

Loss of vision: imaging the visual pathways

This is an overview of diseases presenting with visual impairment, which aims to provide an understanding of the anatomy and pathology of the visual pathways. It discusses the relevant clinical background and neuroimaging findings on CT and standard and advanced MRI of diseases affecting the globe; optic nerve/sheath complex; optic chiasm, tract and radiation; and visual cortex. The overview covers common tumours, trauma, inflammatory and vascular pathology, and conditions such as benign intracranial hypertension and posterior reversible leukoencephalopathy syndrome.