Superior Ophthalmic Vein Approach for Endovascular Treatment of Dural Cavernous Sinus Fistulas

Abstract

We report on our experience in surgical exposure and direct cannulation of the superior ophthalmic vein (SOV) for embolization of dural cavernous fistulas. Surgical incision of the eyelid and direct cannulation of the superior ophthalmic vein was performed in 5 patients. All patients had undergone previous attempts of arterial embolizations and/or transfemoral venous approaches which had failed to reach the fistula site. We were able to occlude the fistulas in all patients in 1 session, resulting in complete angiographic disappearance. In 1 patient surgical cannulation of the superior ophthalmic vein failured due to the specific anatomy, so that it was necessary to perform a direct puncture in the depth of the orbit. All patients showed resolution of clinical symptoms within 2 to 6 months. No complications were observed. The approach via the superior ophthalmic vein is safe and effective for endovascular occlusion of dural cavernous sinus fistulas. Particularly in patients with visual deterioration and unsuccessful on incomplete transfemoral arterial or venous embolizations it represents a valuable alternative. If catheterization of the superior ophthalmic vein is not possible, the direct puncture of the vein deep in the orbit is feasible and may be a last resort.