Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2000 Jul;84(7):771–774. doi: 10.1136/bjo.84.7.771

Orbital arteriovenous malformation mimicking cavernous sinus dural arteriovenous malformation

R Huna-Baron 1, A Setton 1, M Kupersmith 1, A Berenstein 1
PMCID: PMC1723558  PMID: 10873992

Abstract

AIMS—Orbital arteriovenous malformations (OAVM) are rare, mostly described with high flow characteristics. Two cases are reported with an OAVM of distinct haemodynamic abnormality. The clinical, angiographic features, and the management considerations are discussed.
METHODS—Case review of two patients with dural AVM (DAVM) who presented to referral neuro-ophthalmology and endovascular services because of clinical symptoms and signs consistent with a cavernous sinus dural AVM.
RESULTS—In each patient, superselective angiography revealed a small slow flow intraorbital shunt supplied by the ophthalmic artery. The transarterial and transvenous endovascular approaches to treat the malformation were partially successful. Although, the abnormal flow was reduced, complete closure of the DAVM could not be accomplished without significant risk of iatrogenic injury. Neither patient's vision improved after intervention.
CONCLUSION—A DAVM in the orbit can cause similar clinical symptoms and signs to those associated with a cavernous sinus DAVM. Even with high resolution magnetic resonance imaging, only superselective angiography can identify this small intraorbital slow flow shunt. The location in the orbital apex and the small size precludes a surgical option for treatment. The transarterial and transvenous embolisation options are limited.



Full Text

The Full Text of this article is available as a PDF (131.3 KB).

Figure 1  .

Figure 1  

Open in a new tab

Lateral left internal carotid angiogram demonstrates the ophthalmic artery supply (arrow) to the intraorbital AV shunt with drainage to the ophthalmic vein (arrowhead) in the posterior orbit.

Figure 2  .

Figure 2  

Open in a new tab

(a) Lateral early selective injection of the left ophthalmic artery shows the AV network (arrow). (b) The venous phase of the same angiogram demonstrates the enlarged superior division of the ophthalmic vein (large arrowhead) with outflow restriction anteriorly and some draining posteriorly to the cavernous sinus (small arrowhead).

Figure 3  .

Figure 3  

Open in a new tab

Coronal, fat suppressed, gadolinium enhanced magnetic resonance image of the orbit shows increased enhancement of the right optic nerve sheath (arrow).

Figure 4  .

Figure 4  

Open in a new tab

(a) Early lateral right internal carotid angiogram demonstrates a branch (arrow) from the ophthalmic artery supply to the AV shunt. The shunt venous drainage (arrowhead) curves posteriorly to the superior division of the ophthalmic vein. (b) The venous phase of the same angiogram shows the venous side of the shunt (arrowhead) emptying into the ophthalmic vein (curved arrow) with stagnant blood flow suggesting partial thrombosis.

Figure 5  .

Figure 5  

Open in a new tab

Lateral superselective left middle meningeal artery injection demonstrates the AV shunt (arrowhead) filled via a middle meningeal artery collateral (curved arrow), probably through Hyrtl's canal to fill the ophthalmic artery (arrow) before supplying the shunt.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Christie D. B., Kwon Y. H., Choi I., Jakobiec F. A., Woog J. J. Sequential embolization and excision of an orbital arteriovenous malformation. Arch Ophthalmol. 1994 Oct;112(10):1377–1379. doi: 10.1001/archopht.1994.01090220127034. [DOI] [PubMed] [Google Scholar]
  2. Hayes B. H., Shore J. W., Westfall C. T., Harris G. J. Management of orbital and periorbital arteriovenous malformations. Ophthalmic Surg. 1995 Mar-Apr;26(2):145–152. [PubMed] [Google Scholar]
  3. Howard G. M., Jakobiec F. A., Michelsen W. J. Orbital arteriovenous malformation with secondary capillary angiomatosis treated by embolization with silastic liquid. Ophthalmology. 1983 Sep;90(9):1136–1139. doi: 10.1016/s0161-6420(83)80059-1. [DOI] [PubMed] [Google Scholar]
  4. Levy J. V., Zemek L. Ophthalmic arteriovenous malformation. Am J Ophthalmol. 1966 Nov;62(5):971–974. doi: 10.1016/0002-9394(66)91929-5. [DOI] [PubMed] [Google Scholar]
  5. Murali R., Berenstein A., Hirschfeld A. Intraorbital arteriovenous malformation with spontaneous thrombosis. Ann Ophthalmol. 1981 Apr;13(4):457–459. [PubMed] [Google Scholar]
  6. Piske R. L., Lasjaunias P. Extrasinusal dural arteriovenous malformations. Report of three cases. Neuroradiology. 1988;30(5):426–432. doi: 10.1007/BF00404108. [DOI] [PubMed] [Google Scholar]
  7. Rootman J., Kao S. C., Graeb D. A. Multidisciplinary approaches to complicated vascular lesions of the orbit. Ophthalmology. 1992 Sep;99(9):1440–1446. doi: 10.1016/s0161-6420(92)31786-5. [DOI] [PubMed] [Google Scholar]
  8. Schumacher M., Wakhloo A. K. An orbital arteriovenous malformation in a patient with origin of the ophthalmic artery from the basilar artery. AJNR Am J Neuroradiol. 1994 Mar;15(3):550–553. [PMC free article] [PubMed] [Google Scholar]
  9. Tsai F. Y., Wadley D., Angle J. F., Alfieri K., Byars S. Superselective ophthalmic angiography for diagnostic and therapeutic use. AJNR Am J Neuroradiol. 1990 Nov-Dec;11(6):1203–1204. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES