ABSTRACT
Isolated arteriovenous fistulas of the posterior orbit occur with exceptional rarity, and their evaluation and management are not well characterized. We describe the clinical presentation and treatment of a spontaneous arteriovenous fistula of the right posterior orbit via a superior ophthalmic vein approach for embolization using platinum detachable coils.
Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic/instrumentation , Orbit/blood supply , Adult , Angiography, Digital Subtraction , Arteriovenous Fistula/diagnosis , Cavernous Sinus/pathology , Equipment Design , Follow-Up Studies , Humans , Magnetic Resonance Angiography , Male , Maxillary Artery/pathology , Ophthalmic Artery/pathology , Platinum , VeinsABSTRACT
INTRODUCTION: Vein of Galen aneurysmal malformations (VGAM) are assumed to be related to the persistence of the embryonic median prosencephalic vein of Markowski, which does not involute in cases of VGAM and becomes the venous collector of the shunt, characteristic of the malformation. The arterial feeders of VGAMs are all primitive meningeal arteries present during the embryonic period of the constitution of the malformation. It has also been assumed that the internal cerebral veins were absent in patients presenting with VGAM. There is no clear evidence indicating, however, that the deep venous structures cannot develop normally. CASE REPORTS: We report on two cases of VGAM in which superselective retrograde transvenous catheterization and MRI demonstrated that normal internal cerebral veins were draining into the aneurysmal vein of Galen. CONCLUSIONS: It is conceivable that, as in our patients, this drainage pattern is only angiographically detectable via selective retrograde transvenous drainage. The possibility of such normal deep galenic venous drainage must be considered in VGAM management, as it may imply occurrence of adverse effects when the malformation is occluded on the venous side.
