scholarly journals The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

2016 ◽  
Vol 30 (2) ◽  
pp. 230-236
Author(s):  
A. Chiriac ◽  
N. Dobrin ◽  
Georgiana Ion ◽  
V. Costan ◽  
I. Poeata
Keyword(s):  
Cavernous Sinus ◽  
Endovascular Embolization ◽  
Superior Ophthalmic Vein ◽  
Technical Challenge ◽  
Carotid Cavernous Sinus Fistula ◽  
Alternative Routes ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach

Abstract Complex cavernous sinus fistulae (CCF) are still a technical challenge to neurovascular team. The most commonly performed treatment consists in endovascular embolization of the lesion through an arterial or venous approach. Not always these conventional routes are feasible, requiring alternative routes. We report a case of a 44-year-old woman with a complex indirect (Barrow D) carotid cavernous sinus fistula treated by two interventional sessions that imposing a retrograde direct transvenous approach via the superior ophthalmic vein.

Onyx embolization of a carotid cavernous fistula via direct transorbital puncture

2011 ◽  
Vol 114 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Mohamed Samy Elhammady ◽  
Eric C. Peterson ◽  
Mohammad Ali Aziz-Sultan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Agents ◽  
Superior Petrosal Sinus ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach ◽  
Pterygoid Plexus

The treatment of indirect carotid cavernous fistulas (CCFs) is challenging and primarily accomplished by endovascular means utilizing a variety of embolic agents. Transvenous access to the cavernous sinus is the preferred method of embolizaiton of indirect CCFs as they are frequently associated with numerous small-caliber meningeal branches. Although the inferior petrosal sinus is the simplest, shortest, and most commonly used venous route to the cavernous sinus, the superior ophthalmic vein, superior petrosal sinus, basilar plexus, and pterygoid plexus present other endovenous options. Occasionally, however, use of these venous routes may not be possible due to vessel tortuosity or sinus thrombosis and occlusion. The authors report a case of an indirect CCF that could not be treated endovascularly due to inability to access the cavernous sinus via a transfemoral transvenous approach. Angiography revealed a small, deeply located superior ophthalmic vein that was thought to be suboptimal for a direct cutdown. The cavernous sinus was cannulated directly via a transorbital approach using fluoroscopic guidance with a 3D skull reconstruction overlay. The fistula was subsequently obliterated using ethylene vinyl alcohol copolymer (Onyx). The technique and advantages of both 3D osseous reconstruction as well as Onyx embolization are discussed.

scholarly journals Transcutaneous Puncture of the Superior Ophthalmic Vein for Embolization of Dural Carotid-Ophthalmic Fistula

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 9-11 ◽  
Author(s):  
Wen-Hsien Chen ◽  
I-Chen Tsai ◽  
Hou-Chi Huang ◽  
Chun-Han Lin ◽  
Hao-Chun Hung ◽  
...  
Keyword(s):  
Rare Disease ◽  
Endovascular Embolization ◽  
Superior Ophthalmic Vein ◽  
Unique Case ◽  
Special Situation ◽  
Direct Puncture ◽  
Transvenous Approach

Carotid-ophthalmic fistula is a rare disease, which can be treated by transvenous endovascular embolization. Here, we report a unique case with draining vein thrombosed, making a transvenous approach impossible. An old but valuable technique, direct transcutaneous puncture of the superior ophthalmic vein, was used to save the patient's right eye. The old technique, direct puncture of the superior ophthalmic vein, retains its irreplaceable usefulness in this special situation. Thus, interventional neuroradiologists should equip themselves with this essential technique.

Operative Approach Via the Superior Ophthalmic Vein for the Endovascular Treatment of Carotid Cavernous Fistulas That Fail Traditional Endovascular Access

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons293-ons299 ◽  
Author(s):  
Stacey Quintero Wolfe ◽  
Nadia M.A. Cumberbatch ◽  
Mohammad Ali Aziz-Sultan ◽  
Ramachandra Tummala ◽  
Jacques J. Morcos
Keyword(s):  
Signs And Symptoms ◽  
Endovascular Embolization ◽  
Operative Approach ◽  
Superior Ophthalmic Vein ◽  
Contrast Extravasation ◽  
Surgical Access ◽  
Clinical Complications ◽  
Alternative Approach ◽  
Eyebrow Incision ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND Endovascular embolization is the preferred treatment for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of tortuosity, hypoplasia, or stenosis of the normal venous routes. In these cases, direct operative cannulation of the arterialized superior ophthalmic vein (SOV) offers an excellent alternative approach. METHODS We reviewed the records of patients who underwent surgical cannulation of the SOV in preparation for embolization and identified 10 patients with indirect CCF, all of whom presented with ocular signs and symptoms. All had previously undergone unsuccessful endovenous attempts at treatment at our institution. In the operating room, the SOV was catheterized under microscopic magnification through an eyelid or eyebrow incision, and the patients were taken directly to the angiographic suite for embolization. RESULTS In 9 of 10 patients, embolization of the CCF was complete with clinical improvement. In 1 case, navigation of the catheter into the SOV proved difficult, and the procedure was aborted because of contrast extravasation after partial embolization. One patient required a small orbital osteotomy to localize the SOV. There were no clinical complications and no known recurrences. Cosmetic results were excellent in all patients. CONCLUSION Surgical access to the superior ophthalmic vein for embolization of a CCF is an excellent and definitive alternative treatment when traditional endovenous routes are inaccessible. The operative approach to the SOV is straightforward and can be performed safely and expeditiously by the neurovascular team.

Management of carotid-cavernous fistulas by surgery combined with interventional radiology

1983 ◽  
Vol 59 (6) ◽  
pp. 1076-1081 ◽  
Author(s):  
Brian M. Tress ◽  
Kenneth R. Thomson ◽  
Geoffrey L. Klug ◽  
Roger R. B. Mee ◽  
Bruce Crawford
Keyword(s):  
Interventional Radiology ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Superior Ophthalmic Vein ◽  
Detachable Balloon ◽  
Content Type ◽  
First Case ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed. In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical “entrapment” procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration. In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils. The methods and complications of both procedures are discussed.

Bilateral superior ophthalmic vein enlargement associated with diffuse cerebral swelling

1997 ◽  
Vol 86 (5) ◽  
pp. 893-897 ◽  
Author(s):  
Rohit K. Khanna ◽  
Christopher J. Pham ◽  
Ghaus M. Malik ◽  
Eric M. Spickler ◽  
Bharat Mehta ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Graves Disease ◽  
Retrograde Flow ◽  
Cavernous Sinus Thrombosis ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Carotid Cavernous Fistulas ◽  
Tomography Scanning ◽  
Fine Print

✓ Bilateral superior ophthalmic vein (SOV) enlargement has rarely been shown to occur in patients with septic and aseptic cavernous sinus thrombosis, Graves' disease due to obstruction of the SOV by enlarged extraocular muscles, or carotid—cavernous fistulas caused by retrograde flow. The authors describe 11 patients with bilateral SOV enlargement associated with cerebral swelling as detected by computerized tomography scanning. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and elevated intracranial pressure. To the authors' knowledge, this is the first report of bilateral SOV enlargement associated with diffuse cerebral swelling that subsequently resolved after treatment of the cerebral edema. The authors believe that the bilateral SOV enlargement was caused by mechanical cavernous sinus venous stagnation due to cerebral swelling, a syndrome that occurs more commonly than currently appreciated.

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.

scholarly journals A case of carotid cavernous sinus fistula treated with a direct puncture to the thrombosed superior ophthalmic vein

2013 ◽  
Vol 7 (5) ◽  
pp. 345-350 ◽  
Author(s):  
Daisuke WAKUI ◽  
Tomoaki TERADA ◽  
Kosuke OSHIMA ◽  
Homare NAKAMURA ◽  
Yohtaro SAKAKIBARA ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Superior Ophthalmic Vein ◽  
Direct Puncture ◽  
Carotid Cavernous Sinus Fistula

scholarly journals FISTULE CAROTIDO-CAVERNEUSE GEANTE POST-TRAUMATIQUEGIANT TRAUMATIC CAROTID-CAVERNOUS SINUS FISTULA

2020 ◽  
Vol 8 (10) ◽  
pp. 922-925
Author(s):  
M. El. Ikhloufi ◽  
◽  
N. Boutimzine ◽  
E. Cheikh ◽  
M. El Hassani ◽  
...  
Keyword(s):  
Young Patient ◽  
Cavernous Sinus ◽  
Road Accident ◽  
Impact Point ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Carotid Cavernous Sinus Fistula ◽  
Carotid Cavernous Fistulas

Carotid-cavernous fistulas are abnormal arteriovenous communications between the carotid system and the cavernous sinus [1]. They are rare but potentially serious, which can engage the functional and vital prognosis. We report the case of a young patient who presented a giant carotid-cavernous fistula following a road accident with a cranial impact point.

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.

A new transvenous approach to the carotid-cavernous sinus via the inferior petrooccipital vein

2012 ◽  
Vol 116 (3) ◽  
pp. 581-587 ◽  
Author(s):  
Akira Kurata ◽  
Sachio Suzuki ◽  
Kazuhisa Iwamoto ◽  
Kuniaki Nakahara ◽  
Madoka Inukai ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Inferior Petrosal Sinus ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cushing Disease ◽  
Cortical Vein ◽  
The Third ◽  
Cortical Venous Drainage ◽  
Transvenous Approach

Object The transvenous approach via the inferior petrosal sinus (IPS) is commonly used as the most appropriate for carotid-cavernous fistula (CCF) or cavernous sinus sampling. However, sometimes the IPS is not accessible because of anatomical problems and/or complications, therefore an alternative route is needed. In this paper, the authors present and discuss the utility of a transvenous approach to the cavernous sinus via the inferior petrooccipital vein. Methods Four patients, 3 with dural CCFs and the other with Cushing disease, in whom endovascular surgical attempts failed using a conventional venous approach via the IPS, underwent a transvenous approach to the cavernous sinus via the inferior petrooccipital vein (IPOV). One dural CCF case had only cortical venous drainage, the second CCF also mainly drained into the cortical vein with slight inflow into the superior ophthalmic vein and inferior ophthalmic vein, and the third demonstrated drainage into the superior and inferior ophthalmic veins and IPOV. Results In all cases, the cavernous sinus could be accessed successfully via this route and without complications. Conclusions The transvenous approach to the cavernous sinus via the IPOV should be considered as an alternative in cases when use of the IPS is precluded by an anatomical problem and there are no other suitable venous approach routes.

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