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Fig 5. A 12-year-old girl with a large periorbital AVM. A, Anteroposterior view of the right ICA shows the arterial supply to the AVM (arrowheads) via small branches of the ophthalmic artery (arrow). B, External carotid angiogram in the lateral projections demonstrates a large AVM fed by multiple branches of the internal maxillary artery and the anterior branch of the superficial temporal artery. A large venous varix is seen early in the arterial phase draining into the supraorbital and facial veins. C, Percutaneous access to the venous varix is shown with placement of coils and injection of a 1:1 mixture of n-BCA glue and ethiodol oil. Small remaining feeders were then embolized transarterially with Onyx (not shown). D, Postembolizarion right ICA angiogram shows complete cessation of supply from the ophthalmic artery. E, Right external carotid angiogram also demonstrates near-complete thrombosis of the AVM and the venous varix. F, Intraoperative photograph showing the thrombosed AVM mass. Total blood loss at surgery was <200 mL. Intraoperative photograph courtesy of A. Kahana, MD, Department of Ophthalmology, University of Michigan, Ann Arbor, Mich.
