Embolisation of indirect carotid-cavernous sinus dural arterio-venous fistulae using the direct superior ophthalmic vein approach

Abstract

Indirect carotid-cavernous sinus dural arterio-venous fistulae (cDAVF) can be treated by transarterial and/or transvenous embolisation. This study evaluated patients with cDAVF who underwent transvenous embolisation using the direct superior ophthalmic vein (SOV) approach. Between January 2004 and October 2006, eight cDAVF in seven patients were embolised using direct surgical exposure of the SOV when access to the cDAVF via transarterial or transfemoral venous routes was not feasible. Medical records and imaging studies were retrospectively reviewed. The seven patients consisted of four females and three males from 43 to 65-year-old (mean age, 54.4 years). Six cDAVF lesions were located on the left side and two on the right. All fistulae were successfully embolised and showed clinical improvement. One patient presented after treatment with transient venous congestion on the brain stem, which was relieved by osmotic diuretics and steroids. Direct surgical exposure of the SOV for transvenous embolisation of cDAVF can be effective if the facial vein, inferior petrosal sinus, and internal jugular vein are thrombosed. This approach is easy, safe, and effective when performed by a multidisciplinary team.

Cathétérisme de la veine ophtalmique supérieure : traitement d’une fistule durale

“…En effet, cette ponction peut s'accompagner d'un hématome orbitaire compressif, d'une lésion du nerf supra-orbitaire ou du muscle droit supérieur, d'infection ou de granulome secondaire [8]. Cependant lors de rares cas pour lesquels une voie d'abord « classique » est irréalisable (thrombose du sinus pétreux inférieur, absence de communication entre le sinus caverneux et le sinus pétreux inférieur, trajet trop tortueux [9]), cette option paraît être une solution efficace afin de prendre en charge ces anomalies vasculaires [1,10].…”

Endovascular Approaches to the Carotid Cavernous Sinus for Endovascular Treatment of Carotid Cavernous Fistulas and Hormone Sampling

“…Various kinds of venous approaches have been reported: the inferior petrosal sinus (IPS) route was the first established and most commonly used [4][5][6] , especially for venous hormone sampling 2,3 . When the ophthalmic vein [7][8][9][10][11][12][13][14][15][16][17][18][19][20] , superior petrosal sinus (SPS) 21 and pterigoid plexus (PP) 22 are involved in venous drainages of CCFs, each venous channel may become an appropriate access route. …”

“…Direct exposure may damage the superior root of the fifth nerve resulting in numbness of the forehead 17 . Furthermore, it may also cause palsy of the superior levator muscle resulting in palpebral ptosis Direct-puncture approach to the intraconal portion of the SOV has been reported in the literature 13,[15][16][17][18][19][20] . This method is a useful in cases with a dilated SOV only within the intraconal segment, according to the thrombosed branches of the SOV 17 .…”

“…SOV, IOV approach [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Approaches via direct puncture approach to the SOV and IOV and through the SOV from the dilated superficial temporal vein or division of external jugular vein are limited to CCF patients with comparative high flow drainages mainly inflowing into the SOV and/ or the inferior ophthalmic vein (IOV).…”

“…The second and third segments (the intraconal portion) are close to the optic nerve and the orbicular motor nerves. Direct exposure of the SOV roots under general anesthesia is widely used 7-14 ( Fig 4D), but may be complicated and damage may occur to the superior root of the fifth nerve resulting in numbness of the forehead 15 . Furtheremore, it may also cause palsy of the superior levator muscle and palpebral ptosis .…”