Alcohol Embolization of Carotid-Cavernous Indirect Fistulae

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1111-1116
Author(s):  
Christopher J. Koebbe ◽  
Michael Horowitz ◽  
Charles Jungreis ◽  
Elad Levy ◽  
Misha Pless
Keyword(s):  
Intraocular Pressure ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Case Series ◽  
Absolute Ethanol ◽  
Embolic Agent ◽  
Symptom Improvement ◽  
Cavernous Carotid Artery ◽  
Ethanol Embolization ◽  
Balloon Protection

Abstract OBJECTIVE Carotid-cavernous fistulae (CCFs) are abnormal communications between the carotid artery and cavernous sinus that may present with rapid visual deterioration and extraocular paresis as a result of increasing intraocular pressure requiring emergent treatment to preserve vision. We present a technique of balloon-assisted ethanol embolization of the cavernous carotid artery supply to indirect CCFs providing immediate reduction in intraocular pressure with symptomatic improvement. METHODS We reviewed clinical and angiographic data and present a retrospective case series illustrating six patients who underwent endovascular embolization because of worsening visual acuity and extraocular motility disorder caused by CCFs. Cerebral angiography revealed significant blood supply from the cavernous carotid artery to these CCFs. We performed ethanol embolization of these branches with distal balloon protection. RESULTS Five of the six patients experienced immediate and sustained (mean follow-up, 21 mo) decreases in intraocular pressure, with significant symptom improvement. One patient experienced cavernous sinus thrombosis after conclusion of embolization, which caused a temporary worsening of symptoms that improved gradually over time. CONCLUSION Many surgical and endovascular options are available to treat indirect CCFs. Absolute ethanol is a liquid agent that causes immediate vessel sclerosis and occlusion, which makes it a dangerous but potent liquid embolic agent. With distal temporary balloon protection to prevent migration of ethanol, we achieved excellent clinical and angiographic results using absolute ethanol to embolize the cavernous carotid supply to indirect CCFs. This represents a safe and effective method of endovascular management of this complex vascular anomaly.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Management of Cavernous Sinus Meningioma Presenting With Cerebrovascular Insufficiency Secondary to Cavernous Carotid Artery Occlusion: Report of 2 Cases

2018 ◽  
Vol 16 (4) ◽  
pp. 503-513 ◽  
Author(s):  
Gmaan Alzhrani ◽  
Nicholas Derrico ◽  
Hussam Abou-Al-Shaar ◽  
William T Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Cerebrovascular Insufficiency ◽  
Cavernous Sinus Meningioma ◽  
Cavernous Carotid Artery

Abstract BACKGROUND Surgical removal of cavernous sinus meningiomas is challenging and associated with high morbidities as a result of the anatomic location and the surrounding neurovascular structures that are often invaded or encased by the tumor. Advances in radiotherapy techniques have led to the adoption of more conservative approaches in the management of cavernous sinus meningioma. Internal carotid artery encasement and invasion has been documented in these cases; however, ischemic presentation secondary to internal carotid artery stenosis or occlusion by meningioma in the region of the cavernous sinus is rare, with only few cases reported in the literature. OBJECTIVE To report our surgical technique and experience with bypass grafting for cavernous sinus meningiomas that invade or narrow the internal carotid artery. METHODS We report 2 patients who presented with signs and symptoms attributed to cavernous carotid artery occlusion secondary to cavernous sinus meningioma in the last 5 yr. Both patients were treated with flow augmentation without surgical intervention for the cavernous sinus meningioma. RESULTS In both cases, the clinical and radiological signs of cerebrovascular insufficiency improved markedly, and the patients’ tumors are currently being monitored. CONCLUSION Although the cerebrovascular insufficiency in this subset of patients is attributed to the occlusion of the cavernous carotid artery caused by the tumor, we propose treating those patients with flow augmentation first with or without radiation therapy when there is a clear imaging feature suggestive of meningioma in the absence of significant cranial nerve deficit.

Intraluminal occlusion of a carotid-cavernous sinus fistula with a balloon catheter

1971 ◽  
Vol 35 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Donald J. Prolo ◽  
John W. Hanbery
Keyword(s):  
Clinical Trial ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Contrast Material ◽  
Balloon Catheter ◽  
Content Type ◽  
Carotid Cavernous Sinus Fistula ◽  
Cavernous Carotid Artery ◽  
Fine Print

✓ A technique for intraluminal occlusion of a carotid-cavernous sinus fistula with a balloon catheter is described. Passage of a balloon catheter into the cavernous carotid artery from the cervical carotid usually is easily accomplished. Inflation of the balloon with contrast material allows it to be visualized as the fistula is occluded. The simplicity and effectiveness of this method offer advantages over preexisting ones. Appraisal of its usefulness awaits further clinical trial.

Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy

1987 ◽  
Vol 66 (3) ◽  
pp. 468-470 ◽  
Author(s):  
Patrick Courtheoux ◽  
Daniel Labbe ◽  
Christian Hamel ◽  
Pierre-Joel Lecoq ◽  
Marcio Jahara ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Steel Coils ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.

Temporary Balloon Occlusion of the Cavernous Carotid Artery for Removal of an Orbital and Intracranial Foreign Body: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. E1240-E1243 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Barbara Albani ◽  
Thomas J. Masaryk ◽  
Peter A. Rasmussen
Keyword(s):  
Foreign Body ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Angiography Suite ◽  
Cavernous Carotid Artery ◽  
Temporary Balloon Occlusion

Abstract OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1–V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.

Endovascular treatment of cavernous carotid artery aneurysms: A 10-year, single-center experience

2021 ◽  
pp. 197140092110134
Author(s):  
Hubert Lee ◽  
Thomas R Marotta ◽  
Julian Spears ◽  
Dipanka Sarma ◽  
Walter Montanera ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Artery Aneurysm ◽  
Treatment Modalities ◽  
Symptom Improvement ◽  
Consecutive Series ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Cavernous Carotid Artery

Background Cavernous carotid artery aneurysms can be treated by several endovascular techniques including flow diversion (FD) and parent vessel occlusion (PVO). We reviewed our institution’s consecutive series of endovascularly treated cavernous carotid artery aneurysms to compare these two modalities and their associated clinical and radiographic outcomes. Methods All patients harboring a cavernous carotid artery aneurysm treated by FD or PVO from January 2008 to December 2018 were enrolled. Data were collected retrospectively and analyzed on patient presentation, aneurysm dimensions, treatments and related complications, rate of aneurysm occlusion, sac regression, and outcomes. Results Fourteen patients were treated with FD and 12 underwent PVO subsequent to passing a balloon test occlusion. There was no significant difference between treatment modalities in aneurysmal occlusion (97.0 ± 8.4% (FD) vs. 100% (PVO), p = 0.23), degree of sac regression (62.5 ± 16.7% (FD) vs. 56.8 ± 24.3% (PVO), p = 0.49), or near-complete to complete symptom improvement (66.7% (FD) vs. 81.8% (PVO), p = 0.62). Major complications included subarachnoid hemorrhage from aneurysmal rupture in 1 (7.1%) patient post-FD and 2 (16.7%) ischemic strokes following PVO. Conclusions Endovascular treatment of cavernous carotid artery aneurysms by FD or PVO are both effective and safe. There is insufficient evidence to recommend one technique over the other and decision making should be individualized to the patient, their aneurysm morphology, and operator experience.

scholarly journals Cavernous Carotid Artery Pseudoaneurysm Following a Radical Cavernous Sinus Resection

2016 ◽  
Vol 77 (02) ◽  
pp. e102-e105
Author(s):  
Miki Katzir ◽  
Ziv Gil ◽  
José Cohen ◽  
Gill Sviri
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Artery Pseudoaneurysm ◽  
Cavernous Carotid Artery

Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: case series and technical note

2012 ◽  
Vol 32 (5) ◽  
pp. E14 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Pascal Jabbour ◽  
Aaron S. Dumont ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Case Series ◽  
Technical Note ◽  
Arterial System ◽  
Embolic Material ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach

Object Multiple approaches have been used to treat carotid-cavernous fistulas (CCFs). The transvenous approach has become a popular and effective route. Onyx is a valuable tool in today's endovascular armamentarium. The authors describe the use of a balloon-assisted technique in the treatment of CCFs with Onyx and assess its feasibility, utility, and safety. Methods The authors searched their prospectively maintained database for CCFs embolized using Onyx with the assistance of a compliant balloon placed in the internal carotid artery (ICA). Results Five patients were treated between July 2009 and July 2011 at the authors' institution. A balloon helped to identify the fistulous point, served as a buttress for coils, protected from inadvertent arterial embolizations, and prevented Onyx and coils from obscuring the ICA during the course of embolization. No balloon-related complications were noted in any of the 5 cases. All 5 fistulas were completely obliterated at the end of the procedure. Four patients had available clinical follow-ups, and all 4 showed reversal of nerve palsies. Conclusions Balloon-assisted Onyx embolization of CCFs offers a powerful combination that prevents inadvertent migration of the embolic material into the arterial system, facilitates visualization of the ICA, and serves as a buttress for coils deployed in the cavernous sinus through the fistulous point. Despite adding another layer of technical complexity, an intraarterial balloon can provide valuable assistance in the treatment of CCFs.

Suprasellar Displacement of Intracavernous Internal Carotid Artery: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1433-1435 ◽  
Author(s):  
Oren N. Gottfried ◽  
Scott W. Soleau ◽  
William T. Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Vascular Anomaly ◽  
Vascular Abnormality ◽  
Bifurcation Aneurysm ◽  
Sinus Wall ◽  
Anatomic Variants ◽  
Cavernous Carotid Artery

Abstract OBJECTIVE AND IMPORTANCE We present a previously undescribed variant of the cavernous internal carotid artery (ICA) and review the literature concerning other variants of the cavernous ICA. CLINICAL PRESENTATION The patient, a 53-year-old woman with fibromuscular dysplasia and multiple intracranial aneurysms, underwent cerebral angiography in preparation for clipping of a terminal ICA bifurcation aneurysm that demonstrated a redundant loop of the cavernous ICA abutting the supraclinoid carotid artery. INTERVENTION The patient underwent a pterional craniotomy to approach a terminal ICA bifurcation aneurysm. During the procedure, an unexpected vascular anomaly was discovered. On further dissection, we confirmed that the vascular abnormality was a segment of the ICA that had herniated through the superomedial cavernous sinus wall. CONCLUSION This case demonstrates that the cavernous ICA may become dehiscent from the cavernous sinus wall and herniate into the suprasellar space. Knowledge and anticipation of anatomic variants of the cavernous carotid artery are essential to avoid inadvertent vascular injury during surgery.

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