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Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach.
J Neurosurg. 1995 Nov; 83(5):838-42.JN

Abstract

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.

Authors+Show Affiliations

Neuro-Ophthalmology Unit, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

7472552

Citation

Miller, N R., et al. "Treatment of Carotid-cavernous Sinus Fistulas Using a Superior Ophthalmic Vein Approach." Journal of Neurosurgery, vol. 83, no. 5, 1995, pp. 838-42.
Miller NR, Monsein LH, Debrun GM, et al. Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg. 1995;83(5):838-42.
Miller, N. R., Monsein, L. H., Debrun, G. M., Tamargo, R. J., & Nauta, H. J. (1995). Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. Journal of Neurosurgery, 83(5), 838-42.
Miller NR, et al. Treatment of Carotid-cavernous Sinus Fistulas Using a Superior Ophthalmic Vein Approach. J Neurosurg. 1995;83(5):838-42. PubMed PMID: 7472552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. AU - Miller,N R, AU - Monsein,L H, AU - Debrun,G M, AU - Tamargo,R J, AU - Nauta,H J, PY - 1995/11/1/pubmed PY - 1995/11/1/medline PY - 1995/11/1/entrez SP - 838 EP - 42 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 83 IS - 5 N2 - 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. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/7472552/Treatment_of_carotid_cavernous_sinus_fistulas_using_a_superior_ophthalmic_vein_approach_ L2 - https://thejns.org/doi/10.3171/jns.1995.83.5.0838 DB - PRIME DP - Unbound Medicine ER -