Transcranial Orbitotomy for Resection of Orbital Intraconal Arteriovenous Malformation: 2-Dimensional Operative Video

Abstract

Intraorbital arteriovenous malformations (AVMs) are not common, and their prevalence is unknown. 1,2 They can cause significant morbidity, including vision loss, diplopia, chronic pain, and cosmetic deformity. 3 Treatment can be technically difficult because of the challenging anatomical location with multiple adjacent nerves and ophthalmic vascularity, and it may involve endovascular and open surgical procedures or both. 4-6 We present a video illustrating the case of a 45-year-old man with progressive right-sided proptosis and chemosis with intact vision. Magnetic resonance imaging demonstrated an orbital intraconal lesion in the superior lateral aspect. Angiogram confirmed the presence of an AVM fed by branches of the ophthalmic artery and draining to the superior ophthalmic vein. We performed a transcranial orbitotomy for resection of the AVM. Intraoperative angiogram confirmed complete resection of the AVM. The patient consented to the procedure and the publication of his images. Institutional review board approval is waived for single case reports. The patient did well postoperatively, and his proptosis and chemosis resolved. It is important for the skull base surgeon to be adept in treating orbital pathologies safely and effectively given the overlapping of pathologies that may involve the orbit and skull base such as this.