Embolization of Four Cases of Carotid-Cavernous Sinus Fistulas by Retrograde Catheterism of the Superior Orbital Vein

Abstract

According to Dolenc [9] Mont as early as 1935 advocated in cases of carotid- cavernous sinus fistulas (CCSF) with anterior drainage through the superior orbital vein (SOV) the resection and ligature of this vein. He suggested scouring the lumen with a small tube brush soaked in 50% glucose. Also, as described by Dolenc, Brainerd in 1953 attempted to cure an “erectile tumor of the orbit” by retrograde injection of lactate of iron. Dandy et al. in 1937 [3] and 1941 [4] expressed the opinion that the SOV route should not be used for treating CCSF. In 1975 Peterson et al. [11] used a percutaneous approach for passing through the SOV to treat successfully CCSF. In 1981 Debrun et al. [6] maintained that the endovenous route was an excellent way to treat CCSF drained anteriorly through the SOV; however, their first percutaneous approaches failed, and in 1983 [7] Debrun wrote that “retrograde navigation through the SOV was virtually impossible in cases of CCSF with totally or mainly anterior drainage through the ophthalmic veins.” But they were recently successful [8], in two cases using a surgical approach. In fact, Uflacker et al. [13] in 1986 published the most important article on retrograde catheterism through the SOV for treating CCSF drained anteriorly, presenting three successful cases out of five by a surgical approach “deep in the orbit.” Since this article, very few cases of CCSF embolization through the SOV have been published. Here we present four such cases, coming from three different French neuroradiological and neurosurgical teams.