{
  "abstract": "Background Orbital venous malformations (OVMs) are rare, distensible lesions presenting with positional proptosis, pain, acute orbital symptoms. Management is challenging due to complex venous anatomy & risk of non-target embolization, especially with cavernous sinus communication. We report 2 cases using a tailored transvenous cavernous sinus approach, balloon-assisted embolization and adjunctive agents, demonstrating improved safety & curative potential.Methods 2 patients with symptomatic OVMs underwent CT/MRI, venography, 3D RA with Xper CT . Rx performed via transfemoral venous access with selective catheterization of the IPS and cav sinus. A duallumen balloon provided flow control at SOV & variceal outflow. Adjuncts included coil embolization & controlled delivery liquid embo or sclerosing agents.Results In the 1st case, attempted direct percut transorbital access under Xper CT, venogram showed rapid communication with cav sinus; high risk for non-target embolization. The procedure converted to a transvenous approach of cavernous sinus and ophthalmic veins communicating with the malformation. Balloon-assisted flow arrest enabled safe coiling f/b bleomycin sclerotherapy, near-complete varix obliteration . In 2nd case, a primary transvenous strategy used. Dual microcatheter access allowed selective coil occlusion of the IOV to prevent reflux, f/b balloon-assisted Onyx embolization of the varix. This resulted in controlled filling of lesion with preservation of physiologic venous outflows. Resolution of proptosis, pain, no visual deterioration, no cranial neuropathy . Fup imaging confirmed durable obliteration of the varices with intact cav sinus drainage.Conclusion Reproducible, safe transvenous cavernous sinus approach for OVMs, balloon-assisted flow control, selective outflow occlusion & tailored embolic use. Key insight is venographic assessment after direct puncture, with early conversion to a transvenous approach when rapid cav sinus communication is present.Disclosures S. Suggala: None. B. Ghodke: None. A. Cote: None.Abstract E-172 Figure 1A: MRI orbit showing left intra-orbital venous malformation, 1B: Xper Ct guided puncture with venogram showing filling of cavernous sinus. 1C : Retrograde trans IPS to cavernous venogram showing communication with SOV. 1D : Coils in the largest varix and Bleomycin foam injection with flow control. 1E: Coils and stagnant contrast in the malformation. 1F: Post embolization Xper CT Fig: 2A,2B: SOV and IOV, venous varix at the orbital apex, with delayed filling of contrast in varix. 2C,2D: Balloon at confluence of right SOV & IOV with injection of Onyx after blocking IOV outflow with coils 2E,2F: Post transvenous embolization with balloon remodeling technique showing complete obliteration of venous varix",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Washington, Seattle, WA"
      ],
      "name": "S Suggala"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Washington, Seattle, WA"
      ],
      "name": "B Ghodke"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Washington, Seattle, WA"
      ],
      "name": "A Cote"
    }
  ],
  "title": "E-172 Transvenous embolization of symptomatic orbital venous malformations: evolving technical considerations from two cases",
  "uid": "cd5a895e-558b-546c-90d6-09a4ddedd2a5"
}