ORBITAL VENOUS APPROACH TO THE CAVERNOUS SINUS - AN ANALYSIS OF THE FACIAL AND ORBITAL VENOUS SYSTEM

Carotid-cavernous fistulas are abnormal communications between the int ernal carotid artery and the cavernous sinus produced by a rupture of the wall of the carotid artery or one of its branches into the sinus. Extradural branches of the internal or external carotid arteries may c ommunicate with the cavernous sinus, producing proptosis, progressive glaucoma, and ocular vascular engorgement. Various approaches to oblit erate these fistulas have evolved, many of which carry high morbidity or are precluded by anatomical considerations. Analysis of the venous anatomy of the orbit and face, including human cadaver dissections, re veals a new and safe approach to the cavernous sinus, requiring micros urgical isolation and cannulation of the superior ophthalmic vein thro ugh an anterior orbital approach. Selective embolization of a carotid- cavernous fistula can be performed successfully through this route. We present pertinent anatomy and technical considerations and the succes sful clinical application of these principles. Surgeons familiar with craniofacial anatomy and microvascular techniques can apply these prin ciples and play an active role in the treatment of these complex probl ems.