Dural Carotid Cavernous Sinus Fistulas: Interdisciplinary Surgical Embolization via Ophthalmic Vein
Mücke I.1, Schmidbauer J.1, Reith W.2, Struffert T.2, Ruprecht K. W.1
1Dept. of Ophthalmology, University Hospital, Homburg (Saar), 2Dept. of Neuroradiology, University Hospital, Homburg (Saar)
Purpose: Dural carotid cavernous sinus fistulas are cerebral arterio-venous shunts. The fistulas can result in visual impairment and restricted eye movement. The standard therapy is the neuroradiological interventional embolization via femoral artery. In some cases this procedure is not successful because of the angioarchitecture. Therefore, the results of an interdisciplinary surgical embolization via ophthalmic vein are demonstrated.
Method: In four patients suffering from dural carotid cavernous sinus fistulas the standard neuroradiological interventional embolization via femoral artery failed or was impossible. Due to induced severe ocular complications such as visual impairment, progressive exophthalmos, episcleral secundary glaucoma and restricted eye movement, an interdisciplinary surgical procedure was chosen. After anterior orbitotomy platinum coils were placed into the cavernous sinus via either the superior or inferior ophthalmic vein using a microcatheter.
Results: In all cases the platinum coils induced complete thrombosis of the carotid cavernous sinus fistulas. Successful closure was shown by angiography. In the follow, ocular complications resolved completely in all patients.
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