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.
Endovascular Treatment of a Large Venous Pouch Direct Carotid Cavernous Fistula
