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  • Title: [Preliminary investigation on embolization of orbital vascular malformation with medical glue injection intraoperatively].
    Author: Lin TT, He YJ, Zhu LM.
    Journal: Zhonghua Yan Ke Za Zhi; 2018 Jul 11; 54(7):502-508. PubMed ID: 29996611.
    Abstract:
    Objective: To summarize the treatment outcomes of embolizing orbital vascular malformation with intracavitary injection of medical glue during surgery. Methods: A retrospective case series study was performed on 25 patients with orbital vascular malformation who were treated at Tianjin Medical University Eye Hospital during March 2008 and March 2016. In the 25 patients(25 eyes), 7 were male and 18 were female. The range of age was 2-64 years and the median age was 29 years. The clinical features, operation records, pathological reports and follow-up data were analyzed. Results: The location of vascular malformation involved intraorbital in 11 cases and superficial area of eyelid and(or) face in 5 cases, as for the rest 9 cases, both intraorbital and superficial area were involved. Conjunctiva was involved in 4 patients. Clinical manifestation included intermittent protopsis or mass volumn changed (7 cases), pulsating exophthalmos and vascular murmur (1 case). Imaging examination showed solitary mass with regular shape in 5 cases and space occupying lesion with irregular shape and ill-defined margins in 20 cases. Optic nerve was involved in 7 cases. Surgical debulkling were performed via skin incision on the mass surface (in 3 cases), lateral orbitotomy (in 2 cases), and anterior orbitotomy (in 20 cases). The anterior orbitotomy approaches include skin incision under eyebrow (9 cases), skin incision under lower eyelid eyelash (3 cases), transconjunctiva joint lateral canthus incision (6 cases) and transconjunctiva incision only(2 cases). The intra-orbital part of vascular malformation involved intraconal compartment (10 cases) and extraconal compartment (10 cases). During the operation, vascular malformations were exposed and injected with medical aural and encephalic glue. The amount of injected glue ranged from 0.25 ml to 2.50 ml in divided doses. When the soft venous malformations turned hard, the lesions and remnant glue were fully removed. The whole procedure cause less bleeding and shorter time of operation. Histopathologic diagnosis were intraosseous hemangioma (1 case), arteriovenous malformation (2 cases), venous malformation (22 cases), including varix (4 case) and venous hemangioma (18 cases). One patient suffered from sudden central retinal artery embolism on the third day postoperatively, in which case, visual acuity recovered to 0.6 by timely rescue and appropriate procedure. Topical skin aseptic inflammation took place at the same side of medical glue injection in 3 cases which might be caused by medical glue. These 3 cases had superficial eyelid lesions. Postoperative follow up for patient was conducted from 6 months to 5 years. One young patient underwent recurrent orbital hematoma and many times surgery. Conclusions: Embolization of orbital vascular malformation with medical glue injection intraoperatively can be utilized as an easy approach to control hemorrhage. The surgeon should be careful with the application methods, for instance not to push too quickly, not to pass through the vascular malformation, and to remove the lesions and remnant glue completely, in order to avoid complications. (Chin J Ophthalmol, 2018, 54: 502-508). 目的： 总结眼眶血管畸形医用胶注射栓塞后切除手术的疗效。 方法： 回顾性系列病例研究。收集天津医科大学眼科医院2008年3月至2016年3月确诊为眼眶血管畸形并在手术中采用医用胶进行血管团内注射栓塞后切除病变的患者资料，共25例25只眼，男性7例，女性18例；发病年龄2~64岁，中位年龄29岁。总结分析患者的临床特征、手术记录、病理报告和随访资料。 结果： 畸形血管团位于眶内11例，位于眼睑颜面部5例，同时累及眶内及眼睑浅表组织9例。4例伴有结膜受累。影像学检查发现形态规则的孤立性病变5例；形态不规则且边界不清楚的软组织占位20例，其中包绕或压迫视神经7例。手术入路采取肿物表面皮肤切口3例，外侧开眶骨切开2例，前路开眶20例。前路开眶包括眉弓下皮肤切口9例，下睑睫毛下皮肤入路3例，结膜入路联合外眦切开6例，单纯结膜切口2例。暴露畸形血管团前表面后即行医用胶注射，注射量0.25~2.50 ml，其中8例行分次注射。沿固化的血管团周围剥离软组织，完整取出。手术全程出血少。病理诊断动静脉性血管畸形2例，静脉性血管畸形22例（包括静脉曲张4例、静脉性血管瘤18例），骨内血管瘤1例。围手术期并发症包括视网膜中央动脉栓塞1例（经及时抢救视力恢复至0.6），皮肤局部炎性反应3例（均发生在眼睑皮肤浅表病变注射一侧）。术后随访6个月至5年，复发1例，后期经多次手术治疗病情仍反复。 结论： 眼眶血管畸形采用医用胶注射栓塞后切除手术减少了术中、术后出血的风险，血管团易于取出，特别是边界不清的病变更易于彻底切除，但应严格控制推注量，观察推注后组织反应，尽可能避免医用胶溢出畸形血管团外，尽可能全部取出固化的胶体和病变组织，以减少术后并发症。（中华眼科杂志，2018，54：502-508）.
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