Transorbital Glue Embolization of a Recurrent Venous Varix Using Real-Time Image Guidance in the Neuroangiography Suite.

Orbital lesions are challenging to access due to their location amid critical anatomic structures. Here, we demonstrate direct transorbital cannulation of an orbital venous varix using image guidance. A 36-year-old male was diagnosed with a left orbital venous varix approximately 5 years ago at an outside institution. He subsequently underwent surgery for direct intraoperative embolization of the venous varix followed by surgical resection. The patient recently presented to us with left eye pain, proptosis, double vision, and conjunctival hemorrhage precipitated by straining or lying flat. Orbital magnetic resonance imaging showed recurrence of the venous varix, which was then confirmed with digital subtraction angiography and intraprocedural computed tomography (DynaCT, Siemens Healthineers, Erlangen, Germany). Due to scarring from the previous surgery, percutaneous transorbital embolization of the venous varix was planned. The needle trajectory was determined and also visualized in real-time using image guidance (Needle Guidance, Siemens Healthineers). Once the needle reached the desired target, n-butyl cyanoacrylate glue (Codman Neuro, San Jose, California) was injected until nearly the entire venous varix was occluded. There were no complications, and at his postoperative visit the patient reported resolution of all symptoms.