TREATMENT OF CAROTID-CAVERNOUS SINUS FISTULAS USING A SUPERIOR OPHTHALMIC VEIN APPROACH

The authors describe the method and results of treatment of 12 consecu tive patients with carotid-cavernous sinus fistulas (CCFs). Treatment was by embolization via a transvenous approach through the superior op hthalmic Vein (SOV). The CCFs (two direct and 10 dural) had previously been treated unsuccessfully or, for mechanical reasons, could not be treated by the standard techniques of endoarterial balloon occlusion, particle or glue embolization of feeding vessels from one or both exte rnal carotid arteries, or transvenous occlusion of the fistula via the ipsilateral inferior petrosal sinus. All 12 patients were successfull y treated either by advancement of a detachable balloon catheter throu gh the ipsilateral SOV into the cavernous sinus with subsequent inflat ion and detachment of the balloon (11 patients) or by introduction of multiple thrombogenic coils into the fistula via the ipsilateral SOV ( one patient). All patients had complete resolution of symptoms and sig ns after successful occlusion of the CCF. There were no intraoperative complications; however, one patient required postoperative embolizati on of a residual posteriorly draining fistula via the ipsilateral exte rnal carotid artery, and another developed a persistent abducens nerve paresis that eventually required surgical correction. Ten (83.3%) of the 12 patients underwent cerebral angiography 3 to 6 months after sur gery, and none showed evidence of a recurrent fistula. Similarly, none of the 12 patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 6 months to 10 years (mean 64 months). It is concluded that the transve nous approach to the cavernous sinus through the SOV is a safe and eff ective treatment of both direct and dural CCFs that are not amenable t o transarterial or other transvenous approaches.