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 Endovascular Treatment of Traumatic Carotid Cavernous Fistula with Balloon-Assisted Sinus Coiling

2013 ◽  
Vol 19 (4) ◽  
pp. 445-454 ◽  
Author(s):  
Gustavo Andrade ◽  
Moysés L. Ponte De Souza ◽  
Romero Marques ◽  
José Laércio Silva ◽  
Carlos Abath ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Femoral Artery ◽  
Venous Drainage ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Percutaneous Access ◽  
Endovascular Approach ◽  
The Right

This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a “U-turn” maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.

scholarly journals Dural carotid cavernous fistula following hypertensive emergency

2019 ◽  
Vol 12 (9) ◽  
pp. e230823
Author(s):  
Geoffrey Law ◽  
Gavin Docherty
Keyword(s):  
Vision Loss ◽  
Venous Drainage ◽  
Hypertensive Emergency ◽  
Visual Recovery ◽  
Superior Ophthalmic Vein ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Cerebral Angiogram ◽  
Cavernous Fistula ◽  
Type D

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.

scholarly journals Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis

2019 ◽  
Vol 12 (3) ◽  
pp. e227757 ◽  
Author(s):  
Nirupama Kasturi ◽  
Pooja Kumari ◽  
Gayatri Nagarajan ◽  
Nagarajan Krishnan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Cavernous Fistula ◽  
Intravenous Antibiotics ◽  
Post Traumatic

A 48-year-old woman presented with bilateral non-pulsatile proptosis and ophthalmoplegia after 3 days following blunt orbital trauma. It was associated with fever, malaise and loss of vision in right eye. She was provisionally diagnosed with cavernous sinus thrombosis and was treated with intravenous antibiotics with no improvement. A subtle bruit was present on examination, and digital subtraction angiography revealed a right direct (type A) carotid-cavernous fistula (CCF). The patient underwent right coil embolisation of direct CCF. On follow-up at 4 months, her proptosis resolved completely and extraocular movements improved.

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.

scholarly journals Triple Coaxial Catheter Technique for Transfacial Superior Ophthalmic Vein Approach for Embolization of Dural Carotid-Cavernous Fistula

2010 ◽  
Vol 16 (3) ◽  
pp. 264-268 ◽  
Author(s):  
M-H. Yuen ◽  
K-M. Cheng ◽  
Y-L. Cheung ◽  
C-M. Chan ◽  
S.C.H. Yu ◽  
...  
Keyword(s):  
Venous Access ◽  
Transvenous Embolization ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Catheter Technique ◽  
Coaxial Catheter ◽  
Coaxial Catheter System ◽  
Guiding Catheter

We report a triple coaxial catheter technique to facilitate the venous access to the superior ophthalmic vein during transvenous embolization of dural carotid-cavernous fistula (DCCF) via the transfacial venous route. Two patients with transvenous embolization of DCCFs by coils were treated with transfacial superior ophthalmic vein (SOV) approach by the triple coaxial catheter technique. The triple coaxial catheter system consisted of a 6F guiding catheter as the outer catheter and a 4F guiding catheter as the middle catheter and a microcatheter as the inner catheter to help navigation and manipulation. The DCCFs were completely obliterated in both cases. There were no complications associated with the procedure. The ophthalmic symptoms of the patients had totally resolved at two-month follow-up. The triple coaxial catheter technique can be used with the transfacial SOV approach in embolization of DCCF. This technique has two advantages over the double coaxial catheter technique because it offers additional length and support for the distal navigation of microcatheter into the SOV.

scholarly journals Covered Stent Implantation for the Treatment of Direct Carotid-Cavernous Fistula and its Mid-Term Follow-up

2009 ◽  
Vol 15 (2) ◽  
pp. 185-190 ◽  
Author(s):  
F. Briganti ◽  
F. Tortora ◽  
M. Marseglia ◽  
M. Napoli ◽  
L. Cirillo
Keyword(s):  
Internal Carotid ◽  
Covered Stent ◽  
Complete Analysis ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Ocular Manifestations ◽  
Carotid Cavernous Fistulas ◽  
Direct Carotid Cavernous Fistula

Carotid-cavernous fistulas are abnormal arteriovenous communications either directly between the internal carotid artery and the cavernous sinus or between the dural branches of the internal and external carotid arteries. These fistulas predominantly present with ocular manifestations and they are treated mainly by endovascular techniques in most cases. A detailed review of the literature allowed us to make a complete analysis of the information available on the topic. We describe a case of a direct carotid-cavernous fistula occluded by endovascular implantation of a covered stent, showing the persistence of results after three years.

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.

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.

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