Difficult Indirect Carotid-cavernous Fistulas--alternative Techniques to Gaining Access for Treatment

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2014 Oct 23

PMID 25336933

Citations 6

Authors

Nabil El-Hindy

George Kalantzis

Tufail Patankar

Ilias Georgalas

Sreedar Jyothi

Tony Goddard

Bernard Chang

Affiliations

Soon will be listed here.

Abstract

Aims: Carotid-cavernous fistulas (CCFs) are abnormal communications between the carotid arterial system and the cavernous sinus that occur mainly in elderly. Occasionally, treatment of indirect CCFs with conventional endovascular approach through large veins or the inferior petrosal sinus may not be possible. In these cases, a direct surgical cut down on to the superior ophthalmic vein (SOV) is necessary. We describe three such cases of embolization of CCFs through SOV, and their results.

Methods: A retrospective case notes review of treated patients over the past 10 years in one tertiary center constituted our methodology.

Results: The fistulas in two cases were successfully coiled with complete obviation of symptoms and signs. The third case was complicated due to difficulty in canulating a deeply seated vein and so had to be abandoned and catheterized through contralateral superior petrosal sinus and treated with liquid embolic material Onyx(®) successfully.

Conclusion: In cases where conventional access to the cavernous sinus may not be possible due to local variations of anatomy, multidisciplinary surgical approaches via the SOV provide an alternative route to successfully and safely close a CCF. However, unexpected anatomical variations could also be encountered within the SOV for which the surgeon should be prepared.

Citing Articles

Endovascular approaches for the treatment of dural carotid-cavernous fistulas: A systematic review.

Harake E, Nieblas-Bedolla E, Wilseck Z, Chaudhary N, Armonda R, Pandey A Interv Neuroradiol. 2024; :15910199241272595.

PMID: 39113637 PMC: 11571140. DOI: 10.1177/15910199241272595.

Transorbital embolization of cavernous sinus dural arterio-venous malformations with surgical exposure and catheterization of the superior ophthalmic vein.

Trennheuser S, Reith W, Kuhn J, Morris L, Bozzato A, Naumann A Interv Neuroradiol. 2022; 29(6):715-724.

PMID: 35758285 PMC: 10680959. DOI: 10.1177/15910199221110967.

First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case.

Cappuzzo J, Baig A, Metcalf-Doetsch W, Waqas M, Monteiro A, Levy E J Neurosurg Case Lessons. 2022; 3(25):CASE22115.

PMID: 35733840 PMC: 9210268. DOI: 10.3171/CASE22115.

Craniofacial Trauma and Vascular Injury.

Bernath M, Mathew S, Kovoor J Semin Intervent Radiol. 2021; 38(1):45-52.

PMID: 33883801 PMC: 8049762. DOI: 10.1055/s-0041-1724012.

Traumatic posterior communicating artery-cavernous fistula, angioarchitecture, and possible pathogenesis: a case report and literature review.

Du B, Zhang M, Liu Q, Shen J, Wang Y Neuropsychiatr Dis Treat. 2016; 12:707-11.

PMID: 27099501 PMC: 4820229. DOI: 10.2147/NDT.S96588.

References

Wanke I, Doerfler A, Stolke D, Forsting M . Carotid cavernous fistula due to a ruptured intracavernous aneurysm of the internal carotid artery: treatment with selective endovascular occlusion of the aneurysm. J Neurol Neurosurg Psychiatry. 2001; 71(6):784-7. PMC: 1737648. DOI: 10.1136/jnnp.71.6.784. View

Quinones D, Duckwiler G, Gobin P, Goldberg R, Vinuela F . Embolization of dural cavernous fistulas via superior ophthalmic vein approach. AJNR Am J Neuroradiol. 1997; 18(5):921-8. PMC: 8338114. View

de Keizer R . Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit. 2003; 22(2):121-42. DOI: 10.1076/orbi.22.2.121.14315. View

Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O . Endovascular treatment of carotid cavernous sinus fistula: A systematic review. World J Radiol. 2013; 5(4):143-55. PMC: 3647206. DOI: 10.4329/wjr.v5.i4.143. View

Suzuki S, Lee D, Jahan R, Duckwiler G, Vinuela F . Transvenous treatment of spontaneous dural carotid-cavernous fistulas using a combination of detachable coils and Onyx. AJNR Am J Neuroradiol. 2006; 27(6):1346-9. PMC: 8133910. View

Halbach V, Hieshima G, Higashida R, Reicher M . Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol. 1987; 149(3):587-93. DOI: 10.2214/ajr.149.3.587. View

Ellis J, Goldstein H, Connolly Jr E, Meyers P . Carotid-cavernous fistulas. Neurosurg Focus. 2012; 32(5):E9. DOI: 10.3171/2012.2.FOCUS1223. View

Barrow D, Spector R, Braun I, Landman J, Tindall S, TINDALL G . Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985; 62(2):248-56. DOI: 10.3171/jns.1985.62.2.0248. View

Luo C, Teng M, Chang F, Chang C . Traumatic indirect carotid cavernous fistulas: angioarchitectures and results of transarterial embolization by liquid adhesives in 11 patients. Surg Neurol. 2008; 71(2):216-22. DOI: 10.1016/j.surneu.2007.09.032. View

10.

Yu S, Cheng H, Wong G, Chan C, Cheung J, Poon W . Transvenous embolization of dural carotid-cavernous fistulae with transfacial catheterization through the superior ophthalmic vein. Neurosurgery. 2007; 60(6):1032-7. DOI: 10.1227/01.NEU.0000255455.05355.31. View

11.

Ringer A, Salud L, Tomsick T . Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am. 2005; 16(2):279-95, viii. DOI: 10.1016/j.nec.2004.08.004. View

12.

Moron F, Klucznik R, Mawad M, Strother C . Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol. 2005; 26(6):1399-404. PMC: 8149099. View

13.

Tjoumakaris S, Jabbour P, Rosenwasser R . Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am. 2009; 20(4):447-52. DOI: 10.1016/j.nec.2009.07.013. View

14.

Lewis A, Tomsick T, TEW Jr J . Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery. 1995; 36(2):239-44; discussion 244-5. DOI: 10.1227/00006123-199502000-00001. View

15.

Higashida R, Halbach V, Tsai F, Norman D, PRIBRAM H, Mehringer C . Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. AJR Am J Roentgenol. 1989; 153(3):577-82. DOI: 10.2214/ajr.153.3.577. View

16.

Gemmete J, Ansari S, Gandhi D . Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009; 29(1):62-71. DOI: 10.1097/WNO.0b013e3181989fc0. View

17.

Meyers P, Halbach V, Dowd C, Lempert T, Malek A, Phatouros C . Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up. Am J Ophthalmol. 2002; 134(1):85-92. DOI: 10.1016/s0002-9394(02)01515-5. View

18.

Theaudin M, Saint-Maurice J, Chapot R, Vahedi K, Mazighi M, Vignal C . Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients. J Neurol Neurosurg Psychiatry. 2006; 78(2):174-9. PMC: 2077661. DOI: 10.1136/jnnp.2006.100776. View

19.

Kallmes D, Cloft H . The use of hydrocoil for parent artery occlusion. AJNR Am J Neuroradiol. 2004; 25(8):1409-10. PMC: 7975454. View