Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

Abstract

Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.

Cavernous sinus fistulas: Carotid cavernous fistulas and dural arteriovenous malformations

“…In two patients, perforation of the inferior petrosal sinus occurred. Successful embolization of direct CCFs through the superior ophthalmic vein has also been reported [31][32][33]. Complications of endovascular surgery include pseudoaneurysm formation and ocular motor palsies.…”

Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach

“…The symptoms of left proptosis, chemosis and conjunctival congestion have disappeared option because of its ease, less invasion, and high success rate [13,[19][20][21], regardless of its angiographic patency or non-visualisation. Alternative venous approaches also include access through the superior ophthalmic vein (SOV) after surgical exposure [22][23][24] or direct puncture [25], and through the facial vein-SOV [2, 24,26,27]. Other less frequently used approaches, including the superior petrosal sinus [28], the frontal vein [29], direct [30], and the pterygoid plexus [31,32], are rarely reported.…”

Endovascular Treatment of Carotid-Cavernous Fistulas: Review of 12 Cases

“…The treatment of indirect CCF is preferentially performed through retrograde venous catheterization. Preferable sites are the facial, transjugular and superior ophthalmic veins, in which the cavernous sinus can be selectively routed and occluded [2,3,12,20,21] .…”

“…Immediately after the procedures, all patients presented with improved symptoms, including regression of proptosis, chemosis, bruit and tinnitus. In relation to indirect CCF, as in patient number 2, venous catheterization is preferable because it is safer, more easily performed, has a lower incidence of thrombotic events, and a higher success rate [3,4,12,20] . Nevertheless, we present a patient with indirect CCF (patient number 7), in which arterial catheterization was performed achieving complete occlusion of the CCF by using a coil and adhesive liquids (Onyx and cyanoacrylate).…”