Vascular Steal Syndrome, Optic Neuropathy, and Foreign Body Granuloma Reaction to Onyx-18 Embolization for Congenital Orbito-Facial Vascular Malformation

Catherine Y. Liu, Marc A. Yonkers, Tiffany S. Liu, Don S. Minckler, Jeremiah P. Tao

Research output: Contribution to journalArticle

Abstract

A 34-year-old patient presented with a right orbito-facial mass since childhood, consistent with a congenital arteriovenous (AV) malformation. Prior to presentation, she had multiple incomplete surgical resections and embolizations with N-butyl acetyl acrylate and Onyx-18. The patient reported gradual, progressive vision loss shortly after Onyx-18 embolization. Five months after embolization, she presented with decreased vision, disfigurement and mechanical ptosis relating to a large subcutaneous mass affecting the medial right upper eyelid and forehead. Significant exam findings included a visual acuity of 20/400 (20/60 prior to embolization), an afferent pupillary defect, and optic disc pallor. MRI and angiography revealed a persistent AV malformation with feeders from the ophthalmic artery and an absent choroidal flush to the right eye. Pathology from surgical resection showed a significant foreign body giant cell reaction to the embolization material adjacent to the vessels. We suggest that an incomplete embolization with Onyx-18 may have caused vascular steal syndrome from the ophthalmic artery.

Original languageEnglish (US)
Pages (from-to)185-189
Number of pages5
JournalOcular Oncology and Pathology
Volume2
Issue number3
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Embolization
  • Ptosis
  • Vascular lesion

ASJC Scopus subject areas

  • Nursing(all)

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