Abstract
Dural carotid cavernous fistulas are usually treated via a transvenous approach through the inferior petrosal sinus. Surgical exposure and direct access to the superior ophthalmic vein have been previously described in situations in which conventional transvenous access, including the inferior petrosal sinus, is not possible. In this retrospective study of 20 patients, we report our results of imaging-guided percutaneous superior ophthalmic vein access in dural carotid cavernous fistula treatment. The superior ophthalmic vein was accessed after direct percutaneous puncture under sonographic guidance in 16 patients and biplane roadmap guidance in 4 patients. In all 20 patients, it was possible to access the superior ophthalmic vein and cure the dural carotid cavernous fistula. Two patients developed a retrobulbar hematoma after postseptal puncture, which required emergency lateral canthothomy. In our experience, direct imaging-guided percutaneous superior ophthalmic vein access is a safe alternative approach for treatment in situations in which conventional transvenous approaches are not possible.
Highlights
In the case of a thrombosed inferior petrosal sinus (IPS), access through the obstructed sinus is not always possible and access to the cavernous sinus can be achieved through other venous approaches such as the contralateral IPS and across intercavernous sinus communications or via the superior ophthalmic vein (SOV)
Given the limited number of case studies describing imaging-guided access rather than operative exposure, we present our experience in obtaining minimally invasive imaging-guided access to the SOV in situations in which conventional transvenous access to the cavernous sinus is not possible for management of patients with dural carotid cavernous fistula (dCCF)
In 3 patients, the IPS was visualized during the late venous phase of carotid angiography, indicating patency without communication between the IPS and cavernous sinus compartment with its dCCF shunts
Summary
ABBREVIATIONS: dCCF ϭ dural carotid cavernous fistula; IPS ϭ inferior petrosal sinus; SOVϭ superior ophthalmic vein In the case of a thrombosed IPS, access through the obstructed sinus is not always possible and access to the cavernous sinus can be achieved through other venous approaches such as the contralateral IPS and across intercavernous sinus communications or via the superior ophthalmic vein (SOV). Twenty patients who underwent endovascular treatment for dCCF with transvenous embolization after direct imaging-guided percutaneous SOV puncturea
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