Surgical Sparing and Pairing Endovascular Interventions for Carotid-Cavernous Fistula: Case Series and Review of the Literature

Brenna, Connor T. A.; Priola, Stefano Maria; Pasarikovski, Christopher R.; Ku, Jerry C.; Daigle, Patrick; Gill, Hartej; DeSerres, Joshua J.; Antonyshyn, Oleh; Costa, Leodante da; Yang, Victor X. D.

doi:10.1016/j.wneu.2020.05.013

Cited by 9 publications

(14 citation statements)

References 22 publications

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“…Although some reports about ICA aneurysms with CCF exist ( 5 ), and literature on CCF and ECAA separately ( 6 , 7 ), to our knowledge, this is the first study to present cases of CCF and ECAA combination occurring in a patient. Trauma is the most common cause of direct CCF and dissecting aneurysm.…”

Section: Discussionmentioning

confidence: 88%

A case report of multi-step management of extracranial carotid artery aneurysm and carotid-cavernous fistula combination in patients

et al. 2023

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Extracranial carotid artery aneurysms (ECAA) and carotid-cavernous fistulas (CCF) are rare arterial pathologies with severe complications and increased risk of mortality. The optimal treatment approach for this combined condition is a topic of debate among neurosurgeons and neuroradiologists, and a standardized treatment protocol has yet to be established. The aim of this case report was to demonstrate the management of a rare combination of ECAA and CCF in patients. The treatment strategy included a two-step procedure of endovascular embolization of CCF followed by dual antiplatelet therapy and endovascular stenting of an aneurysm. Control angiograms showed the exclusion of an aneurysm from the blood circulation and CCF symptoms were resolved.

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Section: Discussionmentioning

confidence: 88%

A case report of multi-step management of extracranial carotid artery aneurysm and carotid-cavernous fistula combination in patients

et al. 2023

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“… 17–19 , 22 , 34–43 Our systematic review revealed that among the 8 studies reporting the specialist involved in the transpalpebral approach, all except 1 reported performing the procedure with the help of an ophthalmologist or oculoplastic surgeon. 18 , 19 , 22 , 35 , 38 , 39 , 41 This highlights the critical importance of explaining the technical details of the transpalpebral approach from an endovascular neurosurgeon’s perspective so that proceduralists can use this as a guide and perform these procedures independently in cases where an ophthalmologist or oculoplastic surgeon is not available.…”

Section: Discussionmentioning

confidence: 99%

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

Cappuzzo

Baig

Metcalf-Doetsch

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach. OBSERVATIONS An illustrative case, including patient history and presentation, was reviewed. PubMed, MEDLINE, and Embase databases were searched for articles published between January 1, 2000, and September 30, 2021, that reported ≥1 patient with a CCF treated endovascularly via the SOV approach. Data extracted included sample size, treatment modality, surgical technique, performing surgeon specialty, and procedure outcome. The authors’ case illustration demonstrates the technique for the hybrid transpalpebral approach. For the review, 273 unique articles were identified; 14 containing 74 treated patients fulfilled the inclusion criteria. Oculoplastic surgery was the most commonly involved specialty (5 of 14 studies), followed by ophthalmology (3 of 14). Coiling alone was the treatment of choice in 12 studies, with adjunctive use of Onyx (Medtronic) in 2. LESSONS The authors’ technical case description, video, illustrations, and review provide endovascular neurosurgeons with a systematic guide to conduct the procedure independently.

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“…There are alternative transfemoral venous routes such as the superior petrosal sinus and superior ophthalmic vein. More invasive approaches such as direct transorbital puncture or surgery can also be performed in rare circumstances, but these may increase patient comorbidity [ 3 , 6 , 11 , 24 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus

Deniwar

Kwon

Song

et al. 2022

J Korean Neurosurg Soc

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Objective : Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. Methods : In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. Results : Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. Conclusion :The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.

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Surgical Sparing and Pairing Endovascular Interventions for Carotid-Cavernous Fistula: Case Series and Review of the Literature

Cited by 9 publications

References 22 publications

A case report of multi-step management of extracranial carotid artery aneurysm and carotid-cavernous fistula combination in patients

A case report of multi-step management of extracranial carotid artery aneurysm and carotid-cavernous fistula combination in patients

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

Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus

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