Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula

Alaraj, Ali; Kim, Bobby; Oh, Gerald; Aletich, Victor

doi:10.1136/neurintsurg-2013-010704.rep

Cited by 5 publications

(2 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[4,10] In these cases, other transvenous routes can be considered, like the anterior approach through a facial vein or SOV. Some cases of blind direct cannulation of the SOV along with its potential complications [1,4] and direct surgical exposure of the SOV with anterior orbitotomy were described in the past. [4,16] e placement of a flow diverter in the ICA was previously described for the treatment of direct CCFsor Barrow A-type -as un uncommon option only in some case reports.…”

Section: Discussionmentioning

confidence: 99%

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

Brunasso

Casamassima

Abrignani

et al. 2023

Surgical Neurology International

View full text Add to dashboard Cite

Background: Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other “off-label” indications, including solitary or adjunctive treatment to coil embolization for direct (Barrow A type) carotid cavernous fistulas (CCFs). The use of liquid embolic agents still represents the first-line treatment for indirect CCFs. Typically, the ipsilateral inferior petrosal sinus or superior ophthalmic vein (SOV) is the preferred transvenous routes to access CCFs. In some cases, vessel tortuosity or different features make the endovascular access challenging, thus requiring different approaches and strategies. The aim of the study is to discuss rational and technical aspect in treating indirect CCFs referring to the most up-to-date literature. An alternative experience-based endovascular strategy with FD is described. Methods: We report the case of a 54-year-old woman diagnosed with indirect CCF and treated with flow diverter stent. Results: After multiple unsuccessful attempts at transarterial right SOV catheterization, a right indirect CCF fed by a single trunk at the ophthalmic origin from the internal carotid artery (ICA) was treated by ICA stand-alone FD. Blood flow was redirect and successfully reduced through the fistula, with immediately postprocedure improvement of the patient’s clinical status (ipsilateral proptosis and chemosis). Ten-months radiological follow-up showed the complete obliteration of the fistula. No adjunctive endovascular treatment was performed. Conclusion: FD appears a reasonable alternative stand-alone endovascular strategy also for selected difficult-to-access indirect CCFs, when all conventional routes are judged unfeasible. Further investigations will be necessary to better define and support this potential lesson-learned application.

show abstract

Section: Discussionmentioning

confidence: 99%

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

Brunasso

Casamassima

Abrignani

et al. 2023

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Other, less commonly used orbital approaches include direct percutaneous puncture of the SOV, access through the inferior ophthalmic vein, transorbital puncture into the SOV via the extraconal part, and direct puncture of the superior ophthalmic fissure into the cavernous sinus. 17 , 34 , 36 , 37 , 40 , 42 Although direct percutaneous puncture has the advantage of not requiring open surgery, better cosmetic results, and reduced risk of infection, it does carry an inherent high risk of vein perforation and hematoma formation. In a study by Teng et al, 44 patients who underwent direct SOV puncture developed subconjunctival hemorrhages, with 1 patient experiencing an eyelid hematoma.…”

Section: Discussionmentioning

confidence: 99%

First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case

Cappuzzo

Baig

Metcalf-Doetsch

et al. 2022

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach. OBSERVATIONS An illustrative case, including patient history and presentation, was reviewed. PubMed, MEDLINE, and Embase databases were searched for articles published between January 1, 2000, and September 30, 2021, that reported ≥1 patient with a CCF treated endovascularly via the SOV approach. Data extracted included sample size, treatment modality, surgical technique, performing surgeon specialty, and procedure outcome. The authors’ case illustration demonstrates the technique for the hybrid transpalpebral approach. For the review, 273 unique articles were identified; 14 containing 74 treated patients fulfilled the inclusion criteria. Oculoplastic surgery was the most commonly involved specialty (5 of 14 studies), followed by ophthalmology (3 of 14). Coiling alone was the treatment of choice in 12 studies, with adjunctive use of Onyx (Medtronic) in 2. LESSONS The authors’ technical case description, video, illustrations, and review provide endovascular neurosurgeons with a systematic guide to conduct the procedure independently.

show abstract

Long-Term Outcomes of Endovascular Treatment of Indirect Carotid Cavernous Fistulae: Superior Efficacy, Safety, and Durability of Transvenous Coiling Over Other Techniques

et al. 2018

View full text Add to dashboard Cite

BACKGROUND Endovascular surgery is the first-line treatment for indirect cavernous carotid fistulae (CCFs). This study compares multiple treatment techniques. OBJECTIVE To compare endovascular techniques for indirect CCF treatment. METHODS Retrospective analysis was performed of prospectively maintained records at 4 centers, identifying patients undergoing indirect CCF embolization. Demographics, symptoms, and lesion characteristics were recorded. Medical records were reviewed for changes in symptoms, delayed complications, and angiographically proven recurrence. Univariate and multivariate analyses were performed to identify impacts of the above characteristics on outcomes. RESULTS Sufficient records were available for 267 patients treated between January 1987 and December 2016. Obliteration was achieved in 86.5% patients, occurring in 86.9% of exclusively transvenous treatments and 79.5% of other treatments. Obliteration rates were highest following transvenous embolization using coils compared to all other materials (likelihood ratio [LR] 5.0, P = .024). Complications were less common with coil embolization compared to other materials (LR 0.070, P < .001). Embolization with liquid embolics resulted in higher complication rates (LR 10.2, P = .002), although risk was reduced when used in conjunction with coils. Angiographically confirmed recurrence was more common following embolization with polyvinyl alcohol (LR 9.9, P = .004) and when multiple embolic agents were used (LR 6.6, P = .018). Delayed development of symptoms following embolization was less common following embolization with coils (LR 0.20, P = .030) and more common following embolization with liquids (LR 6.5, P = .014). CONCLUSION To treat indirect CCFs, transvenous coil embolization is the safest and most effective technique. Liquid embolics are less effective and have more complications and should be carefully considered only in extenuating circumstances.

show abstract

Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula

Cited by 5 publications

References 22 publications

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case

Long-Term Outcomes of Endovascular Treatment of Indirect Carotid Cavernous Fistulae: Superior Efficacy, Safety, and Durability of Transvenous Coiling Over Other Techniques

Contact Info

Product

Resources

About