PMC3768297_01
Clinical photograph showing proptosis, lid swelling, and conjunctival chemosis of the right eye
SNI-4-107-g001.jpg
PMC3768297_01_SNI-4-107-g001.jpg
F1
Ophthalmologic examination of the right eye disclosed marked dilatation of conjunctival vessels, chemosis, and exophthalmos [Figure 1] with gross reduction of visual acuity (Perception of light).
Head and orbit computed tomography scan demonstrating an isodense, serpiginous soft tissue mass within right retrobulbar space, clearly separate from the optic nerve extending from the superior ophthalmic fissure to the anterolateral orbital wall (a). Contrast enhancement was evident within the neighboring artery (b)
SNI-4-107-g002.jpg
PMC3768297_01_SNI-4-107-g002.jpg
F2
Computed tomography (CT) of the head and orbits demonstrated a nonenhancing, serpiginous soft tissue mass within right retrobulbar space, extending from the superior ophthalmic fissure to the anterolateral wall of the orbit [Figure 2] with no change in the size of the lesion on valsalva maneuvre.
Computed tomography angiogram with 3D reconstruction showing right orbital intraconal dilated and tortuous superior ophthalmic vein (SOV) filled with non enhancing thrombous. Anteriorly, the SOV has several small tributaries
SNI-4-107-g003.jpg
PMC3768297_01_SNI-4-107-g003.jpg
F3
CT angiogram with 3D reconstruction revealed intraconal serpiginous vascular lesion arising from right ICA and ending at the level of SOV, which is grossly dilated and tortuous (2 cm) and filled with nonenhancing thrombous [Figure 3].
Computed tomography angiogram showing no nidus and restricted flow into the thrombosed varix
SNI-4-107-g004.jpg
PMC3768297_01_SNI-4-107-g004.jpg
F4
No nidus and no communication into the cavernous sinus were observed [Figure 4].
Resected specimen of arteriovenous fistula with the thrombous in situ (green arrow)
SNI-4-107-g005.jpg
PMC3768297_01_SNI-4-107-g005.jpg
F5
As the lesion was symptomatic due to dilated thrombosed SOV posing significant mass effect, open surgical excision was planned in our center On opening the orbital roof through fronto-orbital craniotomy, a thickened serpiginous thrombosed SOV was found, which was resected [Figure 5] completely as far back toward the orbital apex as possible after ligation of the proximal feeding artery.
Computed tomography scan plane (a) and contrast (b) at the time of discharge demonstrating complete decompression of the right orbit
SNI-4-107-g006.jpg
PMC3768297_01_SNI-4-107-g006.jpg
F6
CT scan obtained at the time of discharge demonstrated complete decompression of the orbit [Figure 6].