EMBOLIZATION OF DURAL CAVERNOUS FISTULAS VIA SUPERIOR OPHTHALMIC VEINAPPROACH

PURPOSE: To present the results of our treatment of dural cavernous si nus fistulas with surgical exposure of the superior ophthalmic vein (S OV), retrograde venous catheterization, and coil embolization of the c avernous sinus. METHODS: Twelve patients with dural cavernous sinus fi stulas were treated via a retrograde transvenous SOV approach in our h ospital during a 3-year period. All patients had been referred by opht halmologists because of secondary glaucoma and decreased Visual acuity . Angiography showed preferential venous drainage of the dural caverno us sinus fistulas to an enlarged ipsilateral SOV. A total of 13 SOV ex posures were performed, one patient with bilateral fistulas required b ilateral treatment. The vein was surgically exposed by an ophthalmolog ist and then catheterized. Platinum coils were delivered through a mic rocatheter at the fistula site and into the root of the SOV, until the re was complete angiographic closure. RESULTS: Catheterization and emb olization were successful in 12 of the 13 patients, with complete angi ographic occlusion of the fistula. Two patients with bilateral fistula s had transient worsening of symptoms on the contralateral side. Three patients required follow-up angiography. No early complications occur red, and late complications were minor in two cases. All patients exce pt one with long-standing symptoms recovered premorbid visual acuity. At follow-up, 11 (92%) of the 12 embolized fistulas remained occluded. CONCLUSIONS: Retrograde catheterization of the SOV and embolization o f the cavernous sinus with foils is a direct, safe, and efficient way to occlude dural cavernous sinus fistulas.