Treatment of carotid-cavernous sinus fistulas retrograde via the superior ophthalmic vein (SOV)

Jiao, De-rang; Huang, Ying; Yin, Long; Reifa, Sun; Wei, Qiming; Yimu, Fan; Guoxiang, Sung; Shimin, Cui; Xiao, Lan; Wang, Shi; Zunhua, Chen

doi:10.1016/s0090-3019(99)00078-6

Cited by 25 publications

(26 citation statements)

References 11 publications

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“…6 For clinical purposes, however, the term CCF is used based upon the typical ocular features caused by hemodynamic disturbances in the cavernous sinus. 2,5,12 The term 'red-eye' dural shunt syndrome can also be applied. 13 The shunts probably arise as a result of, or may be induced to develop by, microtraumata or vessel wall disorders.…”

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confidence: 99%

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

R¹

2003

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The author investigated 101 cases with direct dural carotid-cavernous and orbital arteriovenous fistulas (CCF). The characteristic clinical findings, such as specific epibulbar arterialized loops, are described and the differential diagnosis of the striking diagnostic triad (exophthalmos, the above-mentioned loops and glaucoma) is discussed, together with the exclusion criteria for other causes of red eyes, episcleral measurements and blood flow. The results of various diagnostic procedures, such as ultrasonography, Doppler hematotachography and color Doppler of the orbit and carotid systems, magnetic resonance imaging and angiography, and of conservative treatment and embolization processes are dealt with successively. The classification of different types of carotid-cavernous fistulas is presented,(1-3) together with the clinical signs in relation to morbidity and mortality during or after conservative or intervention therapies. The importance of patient follow-up, in the clinic as well as with Doppler methods, is emphasized in order to differentiate a progressive or diminished clinical condition caused by spontaneous thrombosis in the healing process or more arteriovenous flow. A 'decision tree' for use in daily practice is provided. In this study, of the 101 cases in which the localization was diagnosed by angiography, 42 were direct (30 traumatic, 12 spontaneous), 31 were dural (3 traumatic, 28 spontaneous) and 10 were orbital CCFs. In 18 other cases, usually dural or orbital shunts, angiography was not performed. For the management of 42 direct fistulas, conservative treatment was used in 12 cases (7 with success; 58%) and balloon embolization was performed in 18 cases (17 with success; 94.5%); the other cases were treated by direct or indirect surgery. Of the 48 (spontaneous and traumatic) dural fistulas, 39 were treated conservatively (32 recovered or were much improved: 82%, of the total cases, 67%). All seven cases in which embolization was performed were cured and/or much improved. In two cases, one fistula was conservatively treated while one was embolized at another location, both with success. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer follow-up period than for the typical dural carotid-cavernous sinus fistulas; in one patient, direct surgery was performed successfully and in one patient the original, non-progressive, orbital features could still be observed.

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confidence: 99%

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

R¹

2003

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189

109

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“…In cases of intraorbital arteriovenous shunts that are found to be AVMs, however, transvenous embolization may result in intraorbital hemorrhage and subsequent worsening of visual function. 3 For this reason, the differential diagnosis between AVF and AVM is important. In our patient, superselective angiography of the OphA was exceptionally helpful in excluding the presence of a nidus.…”

Section: Discussionmentioning

confidence: 99%

Transvenous embolization for a purely intraorbital arteriovenous fistula

Deguchi

Yamada²,

Ogawa³

et al. 2005

Journal of Neurosurgery

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Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

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“…Usually, the transvenous approach is used for indirect CCFs, and the classical approach is used for the trans-IPS route, which can be catheterized even in cases with no visualization of the IPS on angiogram. 14,15,20,23,25,[29][30][31] Sometimes the fistula cannot be approached via the usual trans-IPS access route because of its thrombosis and inaccessibility, so other less commonly used approaches are utilized, such as the trans-SOV route, which can be approached endovascularly, via surgical exposure or by percutaneous catheterization, superior petrosal sinus catheterization, or other alternative routes that are reported in the literature. 16,17,[24][25][26]29,[31][32][33][34][35][36][37][38][39] TAE was used in 2 of our cases (patients 29 and 34; Fig 3).…”

Section: Approach Routesmentioning

confidence: 99%

Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

Hassan

Rashad

Aziz

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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Treatment of carotid-cavernous sinus fistulas retrograde via the superior ophthalmic vein (SOV)

Cited by 25 publications

References 11 publications

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

Transvenous embolization for a purely intraorbital arteriovenous fistula

Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

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