Microsurgical Resection of an Orbital Arteriovenous Malformation with IDSA

Dr. Tatiana Rosenblatt and colleagues demonstrate cranio-orbital microsurgical resection with sequential microvascular clipping and intraoperative digital subtraction angiography (IDSA), a technique not previously described for orbital arteriovenous malformation (AVM) treatment. A 46-year-old woman presented with intractable left eye pain, swelling, ophthalmoplegia, and proptosis that progressed from 5 to 10 mm over 6 weeks of oral steroid therapy. Imaging showed a 15-mm left intraconal orbital AVM with ophthalmic artery involvement and mass effect on the optic nerve that was not amenable to endovascular embolization. Sequential microvascular clipping and IDSA were performed to remove the AVM and its associated varix without compromising optic nerve blood supply.

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