Transfemoral thrombectomy in the cavernous sinus and superior ophthalmic vein

Abstract

Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief. He was neurologically intact without visual deficits at the 2 month follow-up. This is the first report in the literature showing the feasibility of cavernous sinus thrombectomy using current devices and techniques. Early endovascular therapy may help preserve vision in patients with acute CST.

Septic cavernous sinus thrombosis secondary to halo vest pin site infection

“…In the majority of cases, the pathologic microorganism is Staphylococcus aureus followed by Streptococcus pneumoniae, Gram-negative bacilli, and anaerobes [1 , 2 , [4] , [5] , [6] , [7] , [8] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] .…”

“…With respect to the culture, an appropriate empirical antibiotic should be quickly administered and continued for at least three weeks [1 , 2 , [4] , [5] , [6] , [7] , [8] , 20] . Simultaneously, for the resolution of the thrombus; anticoagulant therapy should be initiated [19 , 21 , 24 , 26] . Both of these medications should be switched to oral ones and continued for additional 6 weeks [19 , 21] .…”

“…Recently, for those resistant to medical treatment, endovascular thrombolysis and recanalization have been proposed [24] .…”

Art and Challenges Involved in the Treatment of Ischaemic Damage

“…Given the poor visual prognosis, if not treated urgently, recanalization with mechanical thrombectomy to immediately decrease the IOP and thus to spare the eyesight is mandatory. Anticoagulation therapy alone may not be adequate in cases of CST where vision is acutely threatened by ocular hypertension [98].…”

Causas infrecuentes de proptosis aguda dolorosa. Reporte de casos

“…La vena oftálmica superior se origina en el ángulo superior interno de la cavidad orbitaria y sigue su curso con la arteria orbital superior para drenar en el seno cavernoso. Cualquier alteración que afecte el drenaje venoso de la órbita puede producir proptosis, edema palpebral, dilatación de vasos venosos epiesclerales, hipertensión ocular y limitación de la motilidad ocular 1 .…”