Embolization of carotid cavernous fistulas via the superior ophthalmic vein

Abstract

Treatment of certain types of carotid cavernous fistulas that cannot be closed by the conventional endovascular (arterial and venous) approaches can be successfully closed by using a transvenous approach through the SOV.

Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

“…Despite several publications about the safety, effectiveness, and cosmetically acceptable results [8,9,14,15,19], the transvenous embolization of carotid cavernous fistulas and cavernous sinus-dural fistulas via the superior ophthalmic vein is still not a standard procedure. In the 1980s several interdisciplinary study groups started to try transvenous embolizations via the superior ophthalmic vein [14,20,25,26].…”

“…About 10-15% of all intracranial arteriovenous (AV) malformations are carotid-cavernous sinus fistulas (CCSF) [8,21]. They are an abnormal communication between the carotid artery and the cavernous sinus.…”

“…Beside general symptoms like headache and pulsatile tinnitus, ophthalmologists have to detect, clarify and primarily manage the ocular symptoms. Visual acuity can be reduced due to glaucoma associated to elevated episcleral venous pressure, spontaneous choroidal detachment, diplopia, proptosis with corneal exposure, macular edema, venous stasis retinopathy, or retinal or optic nerve ischemia [8,9,11]. The most common cause of visual loss is the secondary glaucoma [9].…”

“…The most common cause of visual loss is the secondary glaucoma [9]. Indications for treatment of the fistulas are all conditions which threaten or reduce the visual acuity, severe headache or bruit and the risk of intracranial hemorrhage [8]. Today the therapy of symptomatic low-flow carotid cavernous sinus and dural cavernous sinus fistulas is performed through embolization via the femoral artery as a neuroradiologic intervention [10,12,27].…”

“…If the arterial approach fails, because of the location of the fistula or anatomical variations or a combination of those, access via the femoral vein is a frequently successful alternative [2,6,10,13,20,23,24,28]. In a few rare cases a direct surgical approach via the superior ophthalmic vein is the only possibility to embolize the fistula [8,9,14,15,16,18,19,20,21,24].…”