Stereotactic-guided direct orbital puncture for treatment of orbital arteriovenous fistula

J Neurointerv Surg. 2024 Mar 14;16(4):429. doi: 10.1136/jnis-2023-020145.


The patient presented with left-sided chemosis, exophthalmos, and progressive visual loss. Cerebral angiography ed a left orbital arteriovenous malformation and an associated hematoma, with the point of fistulation between the left ophthalmic artery and the anterior section of the inferior ophthalmic vein, with retrograde flow through the superior ophthalmic vein. Transvenous embolization through the anterior facial and angular veins was unsuccessful, with residual shunting. Stereotactic-guided direct venous puncture and Onyx embolization was subsequently performed in the hybrid operating room (OR) to cure the fistula. A subciliary incision allowed for retraction of the orbital contents, creating an optimal trajectory. An endonasal endoscopic approach was performed after the embolization to decompress the orbit. This procedure is shown in video 11-11 neurintsurg;16/4/429/V1F1V1Video 1 .

Keywords: Fistula; Liquid Embolic Material; Navigation; Orbit; Technique.

Publication types

  • Video-Audio Media

MeSH terms

  • Arteriovenous Fistula* / diagnostic imaging
  • Arteriovenous Fistula* / surgery
  • Cavernous Sinus*
  • Embolization, Therapeutic* / methods
  • Humans
  • Intracranial Arteriovenous Malformations* / therapy
  • Orbit / diagnostic imaging
  • Orbit / surgery
  • Punctures