Embolization of Orbital Varices with N-Butyl Cyanoacrylate as an Aid in Surgical Excision: Results of 4 Cases with Histopathologic Examination

Purpose: To report the results of intervention with percutaneously injected n-butyl cyanoacrylate (NBCA) to embolize orbital varices followed by surgical resection. Design: Retrospective case series. Methods: Four patients with symptomatic orbital varices were treated with percutaneous injection of NBCA to embolize the varicosity before surgical resection. Intervention was indicated because of progressive orbital pain attributed to orbital varices. Three of the 4 described cases were associated with severe episodic proptosis. The vision was not affected by the orbital varix in any of the cases before intervention. Radiographic guidance was used during injection of the NBCA. Surgical resection was undertaken via orbitotomy immediately after embolization. The resected tissue was submitted for histopathologic evaluation. Results: Follow-up after surgery ranged from 7 to 19 months. All of the patients experienced relief of orbital pain. All patients noted transient binocular diplopia in extremes of gaze after the procedure, which resolved spontaneously. No patients had diplopia in primary gaze. No patient lost vision as a result of the procedure. There was no difficulty with procedure-related hemostasis in any of the cases. Conclusions: Percutaneously injected NBCA seems to be useful and safe as an aid in visualization and hemorrhage prevention during surgical resection of symptomatic orbital varices.