Orbital Apex Venous Malformation: Case Report on an Unusual Clinical and Radiological Presentation

The authors present a case of an orbital apex venous malformation that presented with an intermittent oculomotor nerve palsy over a 15-year period. Radiologically, the lesion presented as a well-circumscribed orbital mass with T2 hyperintensity and enhancement that could only be demonstrated on 2-hour delayed phase imaging. The venous malformation was initially steroid-responsive but eventually became refractory to medical treatment alone. This necessitated a medial apical decompression, followed by a deep lateral orbitotomy 18 months later.