scholarly journals Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

2020 ◽  
pp. 1-5
Author(s):  
Patrick J. Karas ◽  
Robert Y. North ◽  
Visish M. Srinivasan ◽  
Nathan R. Lindquist ◽  
K. Kelly Gallagher ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vision Loss ◽  
Hybrid Approach ◽  
Venous Drainage ◽  
Direct Access ◽  
Carotid Cavernous Fistula ◽  
Endoscopic Endonasal ◽  
Direct Puncture ◽  
Cavernous Fistula

The classic presentation of a carotid-cavernous fistula (CCF) is unilateral painful proptosis, chemosis, and vision loss. Just as the goal of treatment for a dural arteriovenous fistula (dAVF) is obliteration of the entire fistulous connection and the proximal draining vein, the modern treatment of CCF is endovascular occlusion of the cavernous sinus via a transvenous or transarterial route. Here, the authors present the case of a woman with a paracavernous dAVF mimicking the clinical and radiographic presentation of a CCF. Without any endovascular route available to access the fistulous connection and venous drainage, the authors devised a novel direct hybrid approach by performing an endoscopic endonasal transsphenoidal direct puncture and Onyx embolization of the fistula.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

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.

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.

scholarly journals Development of Indirect Cavernous Dural Arteriovenous Fistula after Trapping for Direct Carotid Cavernous Fistula

2011 ◽  
Vol 17 (1) ◽  
pp. 104-107 ◽  
Author(s):  
H. Yoshino ◽  
H. Ishihara ◽  
F. Oka ◽  
S. Kato ◽  
M. Suzuki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Internal Carotid ◽  
Motor Vehicle ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Direct Carotid Cavernous Fistula

A 60-year-old man with direct carotid cavernous fistula (CCF) due to a motor vehicle accident underwent internal carotid artery trapping following high-flow external carotid to internal carotid artery bypass (EC-IC bypass). Follow-up angiography revealed ipsilateral complex indirect cavernous arteriovenous fistula. Although the traumatic indirect CCF angioarchitecture differs from cavernous-sinus dural arteriovenous fistula (CS-DAVF), the present indirect fistula was similar to the latter. Complex indirect CCF can occur after treatment of direct CCF caused by severe head injury.

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