Transvenous embolization of dural carotid-cavernous fistulae with transfacial catheterization through the superior ophthalmic vein.

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  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
    • Publication Information:
      Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
      Original Publication: Baltimore, Williams & Wilkins.
    • Subject Terms:
      Embolization, Therapeutic*; Carotid-Cavernous Sinus Fistula/*therapy ; Catheterization/*methods ; Eye/*blood supply; Adult ; Aged ; Carotid-Cavernous Sinus Fistula/complications ; Carotid-Cavernous Sinus Fistula/diagnostic imaging ; Cranial Nerve Diseases/etiology ; Cranial Nerve Diseases/prevention & control ; Female ; Hong Kong ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome ; Veins
    • Abstract:
      Objective: We report our experience gaining access to the cavernous sinus via transfacial catheterization of the superior ophthalmic vein through the angular or retromandibular vein. We evaluate the viability of this approach as a safe and convenient alternative pathway for transvenous embolization of the cavernous sinus.
      Methods: This is a retrospective study of 98 patients with symptomatic dural carotid-cavernous fistulae from two major regional hospitals in Hong Kong. All 98 patients presented with one or more ocular symptoms. Seventy-four transvenous embolization procedures were performed on 71 patients. Transvenous access to the cavernous sinus was attempted through various pathways, one by one, until the cavernous sinus was successfully catheterized.
      Results: The overall technical success rate of transvenous embolization of dural carotid-cavernous fistulae in our study was 64 out of 74 patients (86.5%). Had we not used the technique of transfacial catheterization, the technical success rate would have been 53 out of 74 patients (71.6%). After adoption of the transfacial approach, the technical success rate of transvenous embolization became 64 out of 64 patients (100%). Residual symptoms occurred in eight patients. Two patients developed transient VIth cranial nerve palsy after transvenous embolization for 1 and 2 months, respectively. Otherwise, there were no complications.
      Conclusion: Transfacial catheterization through the superior ophthalmic vein is a safe and effective approach and provides a convenient alternative pathway for transvenous embolization of dural carotid-cavernous fistulae when cannulation of the inferior petrosal sinus is not successful, thereby increasing the technical success rate.
    • Publication Date:
      Date Created: 20070601 Date Completed: 20070731 Latest Revision: 20161124
    • Publication Date:
      20231215
    • Accession Number:
      10.1227/01.NEU.0000255455.05355.31
    • Accession Number:
      17538376