Commentary

This article describes a unique presentation of a large intraorbital arteriovenous malformation (AVM) and reviews orbital and ocular adnexal AVMs. Although not exhaustive, the concise summary provides enough background to cover the differential diagnoses. The surgical description is a fine review of a cautious approach to dealing with large lateral intraorbital AVMs involving the superior lateral orbit. As alluded to in this article, smaller AVMs may be considered for intravenous embolization. The success rate of embolizing selected smaller AVMs varies from 10 to 40%. These embolization techniques are associated with the same risk profile as surgical approaches to the same lesions. Grade I AVMs are associated with a 5% surgical risk and their surgical success rate is almost 100%. In contrast, embolization techniques are associated, at best, with a 40% chance of therapeutic control whereas the risk is equivalent to that of surgery. Consequently, most authorities would agree that a surgical approach to orbital AVMs appears to be warranted. The literature and personal experience testify to the efficacy of microembolizing spontaneous and traumatic cavernous-sinus fistulas. Access for embolization can be attained through an upper lid crease cut-down, exposing the superior ophthalmic vein. Gil-Salú, González-Darder, and Vera-Román have presented a case report that highlights a rare but important orbital challenge. They should be congratulated for their endeavors and presentation.