Document Detail

Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access.
MedLine Citation:
PMID:  20489519     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endovascular embolization is the preferred treatment for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of tortuosity, hypoplasia, or stenosis of the normal venous routes. In these cases, direct operative cannulation of the arterialized superior ophthalmic vein (SOV) offers an excellent alternative approach.
METHODS: We reviewed the records of patients who underwent surgical cannulation of the SOV in preparation for embolization and identified 10 patients with indirect CCF, all of whom presented with ocular signs and symptoms. All had previously undergone unsuccessful endovenous attempts at treatment at our institution. In the operating room, the SOV was catheterized under microscopic magnification through an eyelid or eyebrow incision, and the patients were taken directly to the angiographic suite for embolization.
RESULTS: In 9 of 10 patients, embolization of the CCF was complete with clinical improvement. In 1 case, navigation of the catheter into the SOV proved difficult, and the procedure was aborted because of contrast extravasation after partial embolization. One patient required a small orbital osteotomy to localize the SOV. There were no clinical complications and no known recurrences. Cosmetic results were excellent in all patients.
CONCLUSION: Surgical access to the superior ophthalmic vein for embolization of a CCF is an excellent and definitive alternative treatment when traditional endovenous routes are inaccessible. The operative approach to the SOV is straightforward and can be performed safely and expeditiously by the neurovascular team.
Stacey Quintero Wolfe; Nadia M A Cumberbatch; Mohammad Ali Aziz-Sultan; Ramachandra Tummala; Jacques J Morcos
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  293-9; discussion 299     Citation Subset:  IM    
Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA.
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MeSH Terms
Aged, 80 and over
Carotid Artery, Internal / anatomy & histology,  surgery
Carotid-Cavernous Sinus Fistula / pathology,  radiography,  therapy*
Catheterization / methods*
Cavernous Sinus / anatomy & histology,  surgery
Embolization, Therapeutic / methods*
Eyelids / blood supply,  surgery
Forehead / blood supply,  surgery
Intraoperative Complications / etiology,  physiopathology,  prevention & control
Middle Aged
Orbit / blood supply*
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures / methods
Veins / anatomy & histology,  surgery*

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

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