Turkish Neurosurgery
Orbital arteriovenous fistula around the optic nerve treated by transvenous embolization
Masayuki Sato1, Yuji Matsumaru1, Tatsuo Amano1, Yuki Kamiya1
1Toranomon Hospirtal, Department of Neuroendovascular theraphy, Minatoku Tokyo,
DOI: 10.5137/1019-5149.JTN.21114-17.2

(Background) Intraorbital arteriovenous fistula is a very rare disease, therefore an optimal treatment strategy has not yet been established. Here we describe the use of high-resolution cone-beam CT (CBCT) and selective angiography to visualize the detailed anatomy of orbital vessels. The information provided by the intra-operative imaging led to a change in treatment strategy and eventually to successful transvenous coil embolization. (Clinical presentation) A 55-year-old man presented with right exophthalmos, chemosis and diplopia 4 months previously. Magnetic resonance (MR) imaging demonstrated a dilated superior orbital vein. Cerebral angiography showed an intraorbital arteriovenous fistula fed by the branch of the ophthalmic artery and drainage to the superior orbital vein (SOV) and inferior orbital vein (IOV). Super-selective angiography and high-resolution CBCT with diluted contrast medium clarified that feeders of the AV fistula came from the first segment of the ophthalmic artery, and the shunt located surrounding an optic nerve sheath. Transvenous embolization via IOV with coils occluded the AV fistula. (Conclusion) Detailed analysis of intraorbital vessels using high-resolution CBCT and selective angiography led to successful treatment by transvenous coil embolization.

Corresponding author : Yuji Matsumaru