Postpartum Dural Carotid-Cavernous Fistula with Aggressive Angiographic Features: Transvenous Cavernous Sinus Embolization via the Angular-Superior Ophthalmic Vein Using Coils and Onyx, Recanalization, and Transarterial Meningeal Embolization Using Coils and Onyx

2021 ◽  
pp. 1-9
Author(s):  
José E. Cohen ◽  
Gustavo Rajz
Keyword(s):  
Cavernous Sinus ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula

Percutaneous transfemoral embolization of an indirect carotid—cavernous fistula with cortical venous access to the cavernous sinus

1999 ◽  
Vol 90 (5) ◽  
pp. 959-963 ◽  
Author(s):  
Richard J. Bellon ◽  
Amon Y. Liu ◽  
John R. Adler ◽  
Alexander M. Norbash
Keyword(s):  
Cavernous Sinus ◽  
English Literature ◽  
Venous Access ◽  
Retrograde Approach ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Cortical Vein ◽  
Transvenous Approach

✓ The authors present the case of a 61-year-old man with an indirect carotid—cavernous fistula (CCF). Many now advocate a primary transvenous approach to deal with such lesions, with packing and thrombosis of the cavernous sinus leading to fistula obliteration. Transvenous access to the cavernous sinus via the inferior petrosal sinus is the usual route of access; both surgical and transfemoral superior ophthalmic vein approaches are also well described. In the case presented, the anatomy of the CCF was unfavorable for these approaches and its dominant venous egress was via a single enlarged arterialized cortical vein. The cavernous sinus was accessed with a transfemoral retrograde approach to the cortical draining vein. Successful CCF embolization was documented radiographically and clinically. To the authors' knowledge, this procedure has not been previously described in the English literature.

Post-traumatic carotid cavernous fistula: A case report

Trauma ◽  
2021 ◽  
pp. 146040862110317
Author(s):  
Haritha Indulekha ◽  
Sonu Sama ◽  
Saurabh Chandrakar ◽  
Sagarika Panda ◽  
Mohmmad Hashim ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cavernous Sinus ◽  
Road Traffic ◽  
Bone Fractures ◽  
Flail Chest ◽  
Critically Ill Patient ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
History Of

A carotid cavernous fistula is an abnormal connection between the carotid artery and cavernous sinus which is a rare and sight threatening complication of craniofacial trauma. We report a case of a 36-year-old man with history of road traffic accident, flail chest, on mechanical ventilation who developed redness and progressive swelling of right eye. On evaluation, he was found to have right-sided conjunctival chemosis, pulsatile proptosis, and loud bruit on auscultation over right eyeball. Non-contrast computed tomography revealed multiple skull bone fractures with prominence of right-sided cavernous sinus and superior ophthalmic vein. Contrast enhanced magnetic resonance imaging with angiography revealed bulky cavernous sinus with tortuous right superior ophthalmic vein suggestive of right carotid cavernous fistula. Carotid cavernous fistula should be considered as a differential diagnosis for a critically ill patient with history of trauma developing swollen red eyes as the typical signs and symptoms cannot be assessed in patients on mechanical ventilation. The timely diagnosis and prompt treatment can save vision and can improve the outcome.

Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture

2013 ◽  
Vol 119 (1) ◽  
pp. 247-251 ◽  
Author(s):  
Alberto Gil ◽  
Luis López-Ibor ◽  
Gerardo Lopez-Flores ◽  
Hugo Cuellar ◽  
Eduardo Murias ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Foramen Ovale ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Complete Obliteration ◽  
Feasible Alternative ◽  
Carotid Cavernous Fistulas

Endovascular treatment is the treatment of choice for indirect carotid cavernous fistulas (CCFs). Direct surgical obliteration of CCFs is recommended in highly symptomatic patients or in those with an aggressive pattern of venous drainage. However, this is a technically challenging approach associated with significant procedural morbidity. The authors present a case in which they decided to attempt a novel access to the cavernous sinus through the foramen ovale before recommending surgery for an otherwise untreatable dural CCF. This 52-year-old man with an indirect CCF and neurological deficit had undergone several attempts to embolize the shunt by means of the standard approaches. Ultimately direct cavernous sinus access was obtained through the foramen ovale, resulting in complete obliteration of the shunt. The occlusion was radiographically stable at the 6-month follow-up evaluation, and the patient has remained asymptomatic. Percutaneous transovale puncture of a CCF is a feasible alternative to accessing the cavernous sinus when traditional transvenous catheterization or direct superior ophthalmic vein approach is not possible.

scholarly journals Transvenous embolization of dural carotid cavernous fistula through the facial and ophthalmic vein

2011 ◽  
Vol 68 (12) ◽  
pp. 1079-1083 ◽  
Author(s):  
Branko Prstojevic ◽  
Mirko Micovic ◽  
Ivan Vukasinovic ◽  
Mirjana Nagulic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Right ◽  
Transvenous Approach

Introduction. Dural carotid cavernous fistula is acquired, relatively rare, condition comprising of numerous smallcaliber meningeal arterial branches, draining directly into cavernous sinus. Endovascular therapy is the treatment of choice, preferably by a transvenous approach. In the case of inaccessible inferior petrosal sinus, other alternative routes are considered. We presented a case of dural carotid cavernous fistula completely occluded with Guglielmi detachable coils, using a transvenous approach through facial and superior ophthalmic vein. Case report. A 62-year-old man was referred with a gradual worsening proptosis, red eye, and decreased visual acuity, on the right side. Digital subtraction angiography revealed the presence of a right dural carotid cavernous fistula, predominantly supplied from dural branches of the right internal carotid artery siphon, with minimal contribution from the right middle meningeal artery and contralateral dural branches of the left internal carotid artery siphon. The fistula was drainaged through the dilated superior ophthalmic vein, and via the facial to the internal jugular vein. There was neither pacification of pterygoid and petrous sinuses, nor cortical venous reflux. Endovascular treatment was performed by a transvenous approach. A guiding catheter was placed in the right facial vein. A microcatheter was advanced through the dilated angular and superior ophthalmic vein, and its tip positioned into the right cavernous sinus. Coils were deployed, until a complete angiographic occlusion of the fistula had been achieved. The patient experienced rapid improvement in the symptoms, with complete normalization of his condition one month after the treatment. Conclusion. Coil embolization of dural carotid cavernous fistula by transvenous catheterization, through the facial and superior ophthalmic vein, can be considered as safe and effective treatment option in the presence of marked anterior drainage.

Transorbital Endovascular Embolization of Dural Carotid-Cavernous Fistula: Access to Cavernous Sinus through Direct Puncture: Case Examples and Technical Report

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons75-ons83 ◽  
Author(s):  
Shervin R Dashti ◽  
David Fiorella ◽  
Robert F Spetzler ◽  
Felipe C Albuquerque ◽  
Cameron G McDougall
Keyword(s):  
Cavernous Sinus ◽  
Vision Loss ◽  
External Carotid ◽  
Transvenous Embolization ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Direct Puncture ◽  
Cavernous Fistula ◽  
First Case ◽  
History Of

Abstract OBJECTIVE: We present 2 cases of carotid-cavernous fistulas that failed multiple attempts at transarterial and transvenous embolization. Direct transorbital puncture for embolization was successful in curing the fistulas. The relevant anatomy and technique are reviewed. CLINICAL PRESENTATION: The first case is a 39-year-old man who presented with a 2-month history of worsening right-sided chemosis, proptosis, double vision, and progressive right eye vision loss. The second case is a 79-year-old woman with a 5-month history of right-sided chemosis and a 1-month history of complete left ophthalmoplegia. Cerebral angiography revealed an indirect carotid-cavernous fistula (CCF) in both patients, supplied by meningeal branches of the internal and/or external carotid arteries. INTERVENTION: After multiple unsuccessful attempts at transarterial and transvenous embolization, the CCFs were accessed via direct percutaneous transorbital puncture of the inferior and superior ophthalmic veins, respectively. The fistulas were then successfully occluded with a combination of Onyx and detachable coils. CONCLUSION: In rare cases in which more conventional transvenous and transarterial routes to a CCF have been exhausted, direct percutaneous transorbital puncture represents a viable means of achieving catheterization of the fistulous connection. In most cases, where a prominent arterialized superior ophthalmic vein is present, direct puncture represents a reasonable alternative to ophthalmologic cut-down procedures. Transorbital puncture of the inferior ophthalmic vein provides a direct route to the cavernous sinus in cases where the superior ophthalmic vein is atretic and inaccessible by direct surgical cut-down procedures.

Electrothrombosis of carotid-cavernous fistula

1975 ◽  
Vol 42 (1) ◽  
pp. 76-85 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Posterior Segment ◽  
Cerebral Vein ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Arterial Circulation ◽  
Inferior Portion ◽  
Pterygoid Plexus ◽  
Fine Print

✓ The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

Primary treatment of an indirect carotid cavernous fistula by injection of N-butyl cyanoacrylate in the dural wall of the cavernous sinus

2007 ◽  
Vol 67 (4) ◽  
pp. 403-408 ◽  
Author(s):  
Ali Shaibani ◽  
Mehdi Rohany ◽  
Richard Parkinson ◽  
John K. Hopkins ◽  
H. Hunt Batjer ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Primary Treatment ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Dural Wall

Venous rupture during transvenous approach to a carotid-cavernous fistula

1989 ◽  
Vol 71 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Wesley A. King ◽  
Grant B. Hieshima ◽  
Neil A. Martin
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Alternative Methods ◽  
Ocular Motility ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
A Minor ◽  
Transvenous Approach

✓ An attempt at transfemoral transarterial balloon occlusion of a high-flow spontaneous carotid-cavernous fistula was unsuccessful because the carotid artery rent was too small for this approach. During a subsequent transvenous approach to the cavernous sinus through the jugular vein, the inferior petrosal sinus was perforated. A minor subarachnoid hemorrhage occurred before the tear could be sealed by the deposition of three Gianturco coils in the vein. The patient was taken to the operating room for emergency obliteration of the fistula and petrosal sinus in order to remove the risk of further hemorrhage. Under the guidance of intraoperative digital subtraction angiography, isobutyl-2-cyanoacrylate was injected directly into the surgically exposed cavernous sinus. Successful obliteration of the fistula was achieved with preservation of the carotid artery, and the angiography catheter was removed safely from the petrosal sinus. Although initially after surgery the patient had nearly complete ophthalmoplegia, at her 1-year follow-up examination she had normal ocular motility and visual acuity. The transvenous approach to the cavernous sinus and alternative methods of treatment of carotid-cavernous fistulas are discussed.

External carotid-cavernous sinus fistula diagnosed by common carotid arteriography

1974 ◽  
Vol 41 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Louis Wener ◽  
Giovanni Di Chiro ◽  
Robert A. Mendelsohn
Keyword(s):  
Cavernous Sinus ◽  
Carotid Arteries ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Cavernous Sinus Fistula ◽  
The Difference ◽  
Fine Print

✓ An external carotid-cavernous fistula diagnosed by serial common carotid arteriography is reported. The diagnosis was reached on the basis of the difference in time between filling of the distal internal and external carotid arteries and the visualization of the fistula.

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