Cookie cutter technique for percutaneous direct puncture glue embolization of orbital hemangioma in a pediatric patient with NF1

Find out how Dr Saima Ahmad treated a 15-year-old female patient with NF1 and orbital hemangioma.

Case presentation

Patient

15 y.o. / F
Swelling and proptosis of left eye for 12 months
Diagnosed case of NF1 – low IQ
Multiple neurofibromas throughout body
O/E - Marked proptosis, swelling and only light perception in left eye

Swelling and proptosis of left eye x 12 months

Diagnostic MRI

Direct puncture embolization

Direct percutaneous puncture

Introducer sheath 6Fr
Diagnostic catheter 5Fr
Needle 20 G / 19 mm / OD 0.9 mm
Liquid embolic agent – 20 % diluted GLUBRAN Lipiodol

Final DSA Left ICA

Followed by total excision next consecutive day / 70 ml intraoperative blood loss

Followed by total excision following day / 70 ml intraoperative blood loss

F/U CT at discharge

Conclusion

Direct embolization by percutaneous glue puncture saves time and is a safer method for superficial vascular lesions when external compression has been applied with a cookie cutter to reduce venous flow.

Microscopic examination

Histological examination of the submitted biopsy shows stratified squamous lining with underlying inflammation, mucus-secreting gland and multiple vascular channels. Morphological features are of benign vascular channels in favour of a hemangioma.

Opinion

Conjunctival mass, biopsy. Benign vascular channels in favour of hemangioma.