Combined Pretemporal and Endovascular Approach to the Cavernous Sinus for the Treatment of Carotid-Cavernous Dural Fistulae: Technical Case Report

摘要: OBJECTIVE AND IMPORTANCE: The endovascular treatment of carotid-cavernous dural fistulae is becoming the prominent modality for these lesions. intractability lesions and their tendency to recur, especially after previous sessions, exhausts available routes tends present a difficulty in accessing cavernous sinus. To avoid risks associated with direct surgical approach, an alternative, less invasive route sinus using pretemporal extradural approach combined approach. CLINICAL PRESENTATION: A 38-year-old woman presented history right visual ocular symptoms related Type D carotid fistula, which was fed by intemal external branches. fistula initially treated embolization arterial supply. After transient improvement, patient's acuity worsened. follow-up angiogram showed major supply from intracavernous internal branches draining through inferior ophthalmic vein. transvenous not accessible. An attempt cannulate successful. then used. INTERVENTION: region superior orbital fissure exposed. Using microsurgical techniques Doppler flow guidance, anterior cannulated venous drainage channels. intraoperative angiography, thrombogenic coils were deployed at level fistula. Intraoperative angiography confirmed complete obliteration CONCLUSION: (extradural) alternative intractable fistulae.