Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 679-683
DOI: 10.1055/s-0043-1771322
Case Report

Orbital Arteriovenous Fistula Causing Only Visual Impairment due to Compression of the Optic Nerve by the Dilated Superior Ophthalmic Vein

Yudai Hirano
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan
,
Hideaki Ono
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan
,
Masaaki Shojima
2   Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
,
Motoo Abe
3   Department of Ophthalmology, Abe Eye Clinic, Shizuoka, Japan
,
Takeo Tanishima
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan
,
Akira Tamura
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan
,
Isamu Saito
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Orbital arteriovenous fistula (AVF) is a rare disease, and its standard therapeutic strategy has not been established. A 70-year-old male consulted an ophthalmologist due to a visual field defect in his left eye. Neurological findings showed visual impairment but no symptoms such as exophthalmos, conjunctival congestion, or diplopia. Magnetic resonance imaging showed marked dilation of the left superior ophthalmic vein (SOV). Cerebral angiography revealed an AVF that was limited to the left orbit. The feeder was a branch of the ophthalmic artery that originated from the first portion, and the drainer was the SOV, which was meandering and significantly dilated. Since the only symptom was visual impairment, the etiology was considered to be compression of the optic nerve due to a dilated SOV rather than increased venous pressure. Transvenous embolization via the facial vein was performed, and a visual field examination 1 week after the operation revealed marked improvement. Orbital AVF that develops only with visual impairment is extremely rare. As demonstrated with this case, coil embolization for proper position and reduction of the venous pressure, which relieves compression on the optic nerve, may be useful in improving the visual impairment.

Keywords

endovascular treatment - orbital arteriovenous fistula - superior ophthalmic vein - transvenous embolization - visual impairment

Informed Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.




Publication History

Article published online:
13 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Akamatsu Y, Kubo Y, Chida K, Matsumoto Y, Ogasawara K. combined surgical and endovascular treatment of an intraorbital arteriovenous fistula drained into a basal vein of Rosenthal: a technical case report. World Neurosurg 2020; 141: 15-19
    CrossrefPubMedSearch in Google Scholar
  • 2 Tsutsumi S, Oishi H, Nonaka S. et al. Orbital arteriovenous fistula coexistent with an arteriovenous hemangioma: a rare occurrence and review of literature. World Neurosurg 2019; 122: 287-292
    CrossrefPubMedSearch in Google Scholar
  • 3 Konstas AA, Rootman DB, Quiros PA, Ross IB. Transarterial embolization of a spontaneous intraorbital arteriovenous fistula with n-BCA glue. Ophthal Plast Reconstr Surg 2017; 33 (03) e63-e64
    CrossrefPubMedSearch in Google Scholar
  • 4 Lv M, Jiang C, Liu D, Ning Z, Yang J, Wu Z. Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas. Interv Neuroradiol 2015; 21 (03) 357-361
    CrossrefPubMedSearch in Google Scholar
  • 5 Wigton EH, Wells JR, Harrigan MR, Long JA, Vicinanzo MG. Diagnosis and management of an intraorbital vascular fistula. Ophthal Plast Reconstr Surg 2012; 28 (02) e39-e41
    CrossrefPubMedSearch in Google Scholar
  • 6 Williamson RW, Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. Transvenous coil embolization of an intraorbital arteriovenous fistula: case report and review of the literature. Neurosurgery 2013; 72 (01) E130-E134 , discussion E134
    CrossrefPubMedSearch in Google Scholar
  • 7 Caragine Jr LP, Halbach VV, Dowd CF, Higashida RT. Intraorbital arteriovenous fistulae of the ophthalmic veins treated by transvenous endovascular occlusion: technical case report. Neurosurgery 2006; 58 (01) E170 , discussion E170
    Search in Google Scholar
  • 8 Chen BY, Yen PS, Chiang CC, Lin PH, Huang HC. Optic nerve sheath dural arteriovenous fistula mimicking carotid cavernous fistula. Eur Neurol 2018; 80 (01) (02) 17-18
    CrossrefPubMedSearch in Google Scholar
  • 9 Cheng KC, Chang CH, Lin WC. Spontaneous resolution of intraorbital arteriovenous fistulas. Ophthal Plast Reconstr Surg 2009; 25 (03) 245-247
    CrossrefPubMedSearch in Google Scholar
  • 10 Deguchi J, Yamada M, Ogawa R, Kuroiwa T. Transvenous embolization for a purely intraorbital arteriovenous fistula. Case report. J Neurosurg 2005; 103 (04) 756-759
    CrossrefPubMedSearch in Google Scholar
  • 11 Downs E. Optic nerve sheath dural arteriovenous fistula misdiagnosed as a carotid cavernous fistula. J Radiol Case Rep 2018; 12 (02) 1-10
    CrossrefPubMedSearch in Google Scholar
  • 12 Hamada J, Morioka M, Kai Y, Sakurama T, Kuratsu J. Spontaneous arteriovenous fistula of the orbit: case report. Surg Neurol 2006; 65 (01) 55-57 , discussion 57
    CrossrefPubMedSearch in Google Scholar
  • 13 Lee AG, Shader JD, Vickers A, Diaz OM, Bilyk JR. Not the usual suspect. Surv Ophthalmol 2019; 64 (02) 248-253
    CrossrefPubMedSearch in Google Scholar
  • 14 Lin CJ, Blanc R, Clarençon F. et al. Transvenous embolization of an intraorbital arteriovenous fistula using Onyx. J Clin Neurosci 2010; 17 (06) 783-785
    CrossrefPubMedSearch in Google Scholar
  • 15 Naqvi J, Laitt R, Leatherbarrow B, Herwadkar A. A case of a spontaneous intraorbital arteriovenous fistula: clinico-radiological findings and treatment by transvenous embolisation via the superior ophthalmic vein. Orbit 2013; 32 (02) 124-126
    CrossrefPubMedSearch in Google Scholar
  • 16 Sato M, Matsumaru Y, Amano T, Kamiya Y. Orbital arteriovenous fistula around the optic nerve treated by transvenous embolization. Turk Neurosurg 2019; 29 (02) 303-305
    PubMedSearch in Google Scholar
  • 17 Subramanian PS, Gailloud PH, Heck DV, Tamargo RJ, Murphy KJ, Miller NR. Cook detachable coil embolization of a symptomatic, isolated orbital arteriovenous fistula via a superior ophthalmic vein approach. Neuroradiology 2005; 47 (01) 62-65
    CrossrefPubMedSearch in Google Scholar
  • 18 van den Berg R, Smagge LE, Saeed P, Majoie CB. Dural arteriovenous fistula of the optic nerve sheath. Orbit 2009; 28 (06) 417-419
    CrossrefPubMedSearch in Google Scholar
  • 19 Wang CY, Wei LC, Tsuei YS, Chen WH, Shen YC. Intraorbital arteriovenous fistula of the ophthalmic vein-embolization using the thombosed superior ophthalmic vein approach. Can J Ophthalmol 2016; 51 (01) e34-e37
    CrossrefPubMedSearch in Google Scholar
  • 20 de Keizer R. Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit 2003; 22 (02) 121-142
    CrossrefPubMedSearch in Google Scholar
  • 21 Matsumaru Y, Alvarez H, Rodesch G, Lasjaunias PL. Embolisation of branches of the ophthalmic artery. Interv Neuroradiol 1997; 3 (03) 239-245
    CrossrefPubMedSearch in Google Scholar