Ophthalmic vein compression for selected benign low-flow cavernous sinus dural arteriovenous fistulas

Cruz, Juan Pablo; Dijk, Rene van; Krings, Timo; Agid, Ronit

doi:10.3171/2013.2.jns121976

Cited by 9 publications

(9 citation statements)

References 21 publications

(17 reference statements)

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“…Using the thumb over the superomedial orbital rim, compression of the SOV is held for 10 min, and the procedure repeated four to six times daily. 53 Success of this procedure has been demonstrated within a 4-to 6week period in patients wishing to avoid invasive procedures, as well as in patients who have failed attempted endovascular repair. 53 Although a watchful waiting approach is reasonable in many patients with a dural CCF, treatment sometimes is required to prevent long-term sequelae.…”

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confidence: 99%

“…53 Success of this procedure has been demonstrated within a 4-to 6week period in patients wishing to avoid invasive procedures, as well as in patients who have failed attempted endovascular repair. 53 Although a watchful waiting approach is reasonable in many patients with a dural CCF, treatment sometimes is required to prevent long-term sequelae. Indications for intervention include uncontrollable IOP, unremitting diplopia, severe proptosis with corneal exposure, optic neuropathy, retinal ischaemia, severe bruit, and cortical venous drainage from the fistula.…”

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confidence: 99%

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Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

170

237

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A carotid-cavernous fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.

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confidence: 99%

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confidence: 99%

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Henderson

Miller

2017

Eye

170

237

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“…Five (2.9%) patients were taught to perform manual compression of the ophthalmic vein to self-obliterate. 6…”

Section: Methodsmentioning

confidence: 99%

“…Five (2.9%) patients were taught to perform manual compression of the ophthalmic vein to self-obliterate. 6 The remaining 27 (14%) patients were managed conservatively. Twenty-six patients had benign DAVF that were asymptomatic or tolerating their symptoms (with or without medication).…”

Section: Methodsmentioning

confidence: 99%

Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas

et al. 2016

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Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients’ clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure.

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“…To compress IOV, a finger was placed at the inferior orbital rim and pressed it posteriorly for approximately 10 minutes 5 times a day, similar to the SOV compression method. 7 After 5 weeks, the symptoms dramatically improved; her visual acuity was improved to 10/20 and the IOP was reduced to 8 mm Hg with 2 kinds of IOP-lowering agents. Ocular movement was normalized, and conjunctival vessel engorgement was improved (Fig.…”

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Cavernous sinus dural arteriovenous fistula managed by the inferior ophthalmic vein compression

Park

Choung

Son

et al. 2018

Canadian Journal of Ophthalmology

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This article is to report a cavernous sinus dural arteriovenous fistula (CS-DAVF) with increased intraocular pressure (IOP) managed successfully using a conservative method.CS-DAVFs are abnormal shunts between dural arteries and the cavernous sinus. 1 Patients with CS-DAVFs commonly develop ocular symptoms, including increased IOP, diminished vision, proptosis, and corkscrew-like appearance of conjunctival veins due to arterial backflow. 2,3 Most CS-DAVFs without increased IOP can be managed conservatively, 4 expecting spontaneous thrombosis with subsequent closure. 5 However, in cases with decreased visual acuity, increased IOP, or paresis of extraocular muscles, CS-DAVFs should be actively treated 3,6 with endovascular embolization. In some cases with difficult endovascular access, manual compression of the carotid artery or ophthalmic vein is suggested as second option, 7-9 and there have been reports on the manual compression of the carotid artery or superior ophthalmic vein (SOV). However, inferior ophthalmic vein (IOV) compression has not yet been reported. Herein, we present a first case of CS-DAVF, which was managed only with manual compression of the IOV.A 74-year-old female visited our hospital with painless swelling of her right upper eyelid, which lasted for 2 weeks (Fig. 1A). She was previously diagnosed with normal-tension glaucoma in her left eye and treated with Combigan ® BID (brimonidine tartrate/timolol maleate ophthalmic solution). She had been treated with hormone replacement therapy for her postmenopausal symptoms. She denied any history of systemic hypertension, trauma, cranial surgery, or recent illness. 1 At the initial examination, her visual acuity was 8/20 OD with her own glasses, but was originally 18/20 OD 6 months earlier. Her IOP was 38 mm Hg OD, and exophthalmometric values were 13 mm OD and 9 mm OS. The eyeball movement was limited in all directions and relative afferent pupillary defect was observed on her right eye. Slit-lamp examination revealed conjunctival vessel engorgement (Fig. 1B). Contrast-enhanced computed tomography showed engorged SOV and IOV (Fig. 1C). Transfemoral cerebral angiography showed an arteriovenous fistula at the right superior orbital fissure (SOF), which was fed by dural branches from the right Fig. 1 -Photograph and imaging of the patient before and after manual IOV compression. At initial presentation, eyelid swelling (A) and corkscrew-like conjunctival vessel engorgement (B) were observed. On CT, the SOV was engorged (C, black arrow). After manual compression of the IOV, eyelid swelling and conjunctival vessel engorgement disappeared (D, E) and follow-up MR T1 imaging confirmed a complete lesion resolution (F). Right exophthalmos became disappeared (C, F). CT, computed tomography; SOV, superior ophthalmic vein; IOV, inferior ophthalmic vein; MR, magnetic resonance.

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Ophthalmic vein compression for selected benign low-flow cavernous sinus dural arteriovenous fistulas

Cited by 9 publications

References 21 publications

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Carotid-cavernous fistula: current concepts in aetiology, investigation, and management

Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas

Cavernous sinus dural arteriovenous fistula managed by the inferior ophthalmic vein compression

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