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.

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.

Treatment of posttraumatic carotid-cavernous fistula using a detachable balloon catheter

1980 ◽  
Vol 53 (6) ◽  
pp. 784-786 ◽  
Author(s):  
Aldo Benati ◽  
Adriano Maschio ◽  
Stefano Perini ◽  
Alberto Beltramello
Keyword(s):  
Blood Flow ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Blood Flow ◽  
Fine Print

✓ Five cases of posttraumatic carotid-cavernous fistula are reported. The fistulas were occluded by intravascular detachable balloons, as described by Serbinenko and later modified by Debrun. The good results obtained in three of these patients illustrate the value of this procedure, as it allows a direct obliteration of the fistula with preservation of the internal carotid blood flow.

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 carotid-cavernous sinus fistulas using a superior ophthalmic vein approach

1995 ◽  
Vol 83 (5) ◽  
pp. 838-842 ◽  
Author(s):  
Neil R. Miller ◽  
Lee H. Monsein ◽  
Gerard M. Debrun ◽  
Rafael J. Tamargo ◽  
Haring J. W. Nauta
Keyword(s):  
Cavernous Sinus ◽  
Intraoperative Complications ◽  
Balloon Catheter ◽  
Balloon Occlusion ◽  
External Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Transvenous Approach ◽  
Symptoms And Signs ◽  
Fine Print

✓ The authors describe the method and results of treatment of 12 consecutive patients with carotid-cavernous sinus fistulas (CCFs). Treatment was by embolization via a transvenous approach through the superior ophthalmic vein (SOV). The CCFs (two direct and 10 dural) had previously been treated unsuccessfully or, for mechanical reasons, could not be treated by the standard techniques of endoarterial balloon occlusion, particle or glue embolization of feeding vessels from one or both external carotid arteries, or transvenous occlusion of the fistula via the ipsilateral inferior petrosal sinus. All 12 patients were successfully treated either by advancement of a detachable balloon catheter through the ipsilateral SOV into the cavernous sinus with subsequent inflation and detachment of the balloon (11 patients) or by introduction of multiple thrombogenic coils into the fistula via the ipsilateral SOV (one patient). All patients had complete resolution of symptoms and signs after successful occlusion of the CCF. There were no intraoperative complications; however, one patient required postoperative embolization of a residual posteriorly draining fistula via the ipsilateral external carotid artery, and another developed a persistent abducens nerve paresis that eventually required surgical correction. Ten (83.3%) of the 12 patients underwent cerebral angiography 3 to 6 months after surgery, and none showed evidence of a recurrent fistula. Similarly, none of the 12 patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 6 months to 10 years (mean 64 months). It is concluded that the transvenous approach to the cavernous sinus through the SOV is a safe and effective treatment of both direct and dural CCFs that are not amenable to transarterial or other transvenous approaches.

Microsurgical removal of a balloon embolus to the internal carotid artery

1983 ◽  
Vol 58 (1) ◽  
pp. 112-116 ◽  
Author(s):  
David J. Chalif ◽  
Eugene S. Flamm ◽  
Alex Berenstein ◽  
In Sup Choi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Neurological Deficit ◽  
Volume Expansion ◽  
Internal Carotid ◽  
Detachable Balloon ◽  
Neurological Sequelae ◽  
Content Type ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A complication of treatment of posttraumatic carotid-cavernous fistulas by detachable balloon techniques is presented. During occlusion of the fistula, a balloon embolus migrated from the cavernous sinus into the bifurcation of the internal carotid artery. The resultant neurological deficit was immediately treated with hypertension and volume expansion. The patient underwent direct microsurgical embolectomy and suffered no postoperative neurological sequelae. The significance and management of this complication are discussed.

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.

The suboccipital cavernous sinus

1997 ◽  
Vol 86 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
T. Glenn Pait ◽  
Ali F. Krisht ◽  
Muhammad M. Husain
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Microsurgical Anatomy ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Anatomical Structures ◽  
Content Type ◽  
Arterial Walls ◽  
Pathological Conditions ◽  
Fine Print

✓ The authors studied the microsurgical anatomy of the suboccipital region, concentrating on the third segment (V3) of the vertebral artery (VA), which extends from the transverse foramen of the axis to the dural penetration of the VA, paying particular attention to its loops, branches, supporting fibrous rings, adjacent nerves, and surrounding venous structures. Ten cadaver heads (20 sides) were fixed in formalin, their blood vessels were perfused with colored silicone rubber, and they were dissected under magnification. The authors subdivided the V3 into two parts, the horizontal (V3h) and the vertical (V3v), and studied the anatomical structures topographically, from the superficial to the deep tissues. In two additional specimens, serial histological sections were acquired through the V3 and its encircling elements to elucidate their cross-sectional anatomy. Measurements of surgically and clinically important features were obtained with the aid of an operating microscope. This study reveals an astonishing anatomical resemblance between the suboccipital complex and the cavernous sinus, as follows: venous cushioning; anatomical properties of the V3 and those of the petrous—cavernous internal carotid artery (ICA), namely their loops, branches, supporting fibrous rings, and periarterial autonomic neural plexus; adjacent nerves; and skull base locations. Likewise, a review of the literature showed a related embryological development and functional and pathological features, as well as similar transitional patterns in the arterial walls of the V3 and the petrous-cavernous ICA. Hence, due to its similarity to the cavernous sinus, this suboccipital complex is here named the “suboccipital cavernous sinus.” Its role in physiological and pathological conditions as they pertain to various clinical and surgical implications is also discussed.

Intracranial mycotic aneurysms of extravascular origin

1972 ◽  
Vol 36 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Charas Suwanwela ◽  
Nitaya Suwanwela ◽  
Srisakul Charuchinda ◽  
Chaturaporn Hongsaprabhas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Fine Print

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.

scholarly journals Balloon-Assisted Coiling of the Cavernous Sinus to Treat Direct Carotid Cavernous Fistula

2013 ◽  
Vol 19 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Alioscia De Renzis ◽  
Sergio Nappini ◽  
Arturo Consoli ◽  
Leonardo Renieri ◽  
Nicola Limbucci ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Detachable Balloon ◽  
Technical Improvement ◽  
Complete Occlusion ◽  
Persistent Symptoms ◽  
Safe Technique ◽  
Carotid Cavernous Fistulas ◽  
Direct Carotid Cavernous Fistula

This study evaluated clinical and neuroradiological results in 13 consecutive patients with spontaneous and traumatic direct carotid cavernous fistulas treated at our center between January 2006 and September 2012. All patients were treated by coiling of the cavernous sinus. Coiling was always performed while a semi-compliant non-detachable balloon was temporarily inflated in the internal carotid artery. This technique (balloon-assisted coiling) permitted a clear visualization of the fistula, facilitated coil positioning and protected the patency of the artery. All patients' clinical data and radiological examinations were reviewed; nine patients underwent radiological and clinical follow-up, with a mean duration of 3.8 years (range: six months-six years). Overall results at discharge showed a complete occlusion of the fistula in seven patients (7/13, 54%) and a resolution of symptoms in eight patients (8/12, 67%). Radiological follow-up showed complete occlusion of the fistula in all patients (9/9, 100%) and clinical follow-up showed a resolution of symptoms in eight patients (8/9, 89%) and persistent symptoms in one (1/9, 11%). No procedure-related complications occurred. Balloon-assisted coiling of the cavernous sinus for the treatment of direct carotid cavernous fistulas proved an effective and safe technique, both in angiographic and clinical terms, and may be considered a technical improvement.

Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection

1997 ◽  
Vol 87 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Chandranath Sen ◽  
Karin Hague
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Complete Resection ◽  
Nerve Function ◽  
Content Type ◽  
Factors Affecting ◽  
Cranial Nerve Function ◽  
Histological Factors ◽  
Fine Print

✓ Despite advances in the surgical treatment of meningiomas located at the skull base, surgery for meningiomas involving the cavernous sinus remains controversial. The controversy centers on whether complete resection of such a meningioma is possible while preserving cranial nerve function. To evaluate this question, the authors examined six patients with benign meningiomas involving the cavernous sinus. The pathological features of these tumors were evaluated and compared with the normal histoarchitecture of the cavernous sinus. The tendency of these tumors to be infiltrative is evident and this seems to occur along connective tissue planes within the cavernous sinus. This invasiveness can be explained by the peculiar structure of this region. The trigeminal nerve and ganglion seem to be particularly prone to invasion; this does not correlate with the degree of preoperative impairment of nerve function. Internal carotid artery invasion occurs frequently and can be seen even when there is no narrowing of the artery on arteriography. The pituitary gland can also be invaded by the tumor, which penetrates the thin dural barrier.

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