Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

摘要: Background: Treatment of choice for symptomatic carotid–cavernous and cavernous–dural fistulas is neuroradiologic intervention via the femoral artery. Owing to location fistula and/or anatomic variations, a direct surgical approach superior ophthalmic vein may be necessary embolization. Methods: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, secondary glaucoma. One patient had visual impairment scotoma due compression optic nerve by fistula. The tentative diagnosis an arteriovenous was confirmed in two cases color Doppler imaging all three cerebral arterial angiography (two fistulas, one fistula). After unsuccessful transarterial attempt, embolization chosen. Results: In preparation performed without any complications. could embolized completely platinum coils. placement microcatheter impossible, because abnormal vascular pattern. Later on successfully vein. All complete resolution symptoms. There were no recurrences. Conclusion: Embolization represents safe effective treatment when standard access impossible. cooperation orbital surgeon invasive neuroradiologist can benefit this rare group patients.