Percutaneous drainage and ablation of orbital dermoid cysts.

BACKGROUND: Vision-threatening intraorbital dermoid cysts have traditionally been treated by complete surgical resection. Such radical surgical intervention may pose serious risks to both vision acuity and cosmesis. We describe a novel, minimally invasive approach for the treatment of orbital dermoid cysts. METHODS: This is an interventional retrospective case series. Two patients (17 and 4 years) presented with large intraorbital dermoid cysts. The first patient had a dumbbell-shaped lesion involving the temporalis fossa and superotemporal orbit. The second patient had a large, superior intraorbital lesion. Both patients presented with visual disturbance, globe displacement, and eyelid ptosis. A series of techniques were developed and implemented for percutaneous access, drainage, and catheter-based ablation (dual drug technique) of both orbital dermoid cysts. Initial access was gained with a 14-gauge angiocatheter needle system, followed by serial emulsification and drainage of the cyst contents. A 5-French catheter was coaxially placed for fluoroscopic contrast cyst definition and subsequent dual drug chemical ablation (sodium tetradecyl sulfate and ethanol). Suction drainage was maintained for 24 hours following ablation. RESULTS: Radiological and clinical evaluation demonstrated complete resolution of the dermoid cysts with no recurrence at 12-month follow-up in the first patient and 3 months in the second patient. Cosmetic results were excellent. Patients reported no pain and there were no neurologic, oculomotor, infectious, hemorrhagic, or other complications. CONCLUSIONS: Minimally invasive percutaneous drainage and ablation appears to be a promising treatment for large orbital dermoid cysts which would otherwise require extensive surgery to excise. Collaboration of an ophthalmologist and interventional radiologist is essential for evaluation, treatment, and follow-up.