Document Detail

Onyx embolization of a carotid cavernous fistula via direct transorbital puncture.
MedLine Citation:
PMID:  20136392     Owner:  NLM     Status:  MEDLINE    
The treatment of indirect carotid cavernous fistulas (CCFs) is challenging and primarily accomplished by endovascular means utilizing a variety of embolic agents. Transvenous access to the cavernous sinus is the preferred method of embolizaiton of indirect CCFs as they are frequently associated with numerous small-caliber meningeal branches. Although the inferior petrosal sinus is the simplest, shortest, and most commonly used venous route to the cavernous sinus, the superior ophthalmic vein, superior petrosal sinus, basilar plexus, and pterygoid plexus present other endovenous options. Occasionally, however, use of these venous routes may not be possible due to vessel tortuosity or sinus thrombosis and occlusion. The authors report a case of an indirect CCF that could not be treated endovascularly due to inability to access the cavernous sinus via a transfemoral transvenous approach. Angiography revealed a small, deeply located superior ophthalmic vein that was thought to be suboptimal for a direct cutdown. The cavernous sinus was cannulated directly via a transorbital approach using fluoroscopic guidance with a 3D skull reconstruction overlay. The fistula was subsequently obliterated using ethylene vinyl alcohol copolymer (Onyx). The technique and advantages of both 3D osseous reconstruction as well as Onyx embolization are discussed.
Mohamed Samy Elhammady; Eric C Peterson; Mohammad Ali Aziz-Sultan
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-02-05
Journal Detail:
Title:  Journal of neurosurgery     Volume:  114     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-03     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  129-32     Citation Subset:  AIM; IM    
Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
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MeSH Terms
Carotid-Cavernous Sinus Fistula / therapy*
Cerebral Angiography
Dimethyl Sulfoxide / therapeutic use*
Embolization, Therapeutic / methods*
Middle Aged
Polyvinyls / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Onyx copolymer; 0/Polyvinyls; 25067-34-9/ethylene-vinyl alcohol copolymer; 67-68-5/Dimethyl Sulfoxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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