Surgical transvenous embolization of spontaneous carotid cavernous sinus fistulas in two patients

Background: Arteriovenous communications in which blood flows from meningea l branches of the internal and external carotid arteries into the venous ci rculation around and in the cavernous sinus are termed spontaneous (dural) carotid sinus cavernous fistulas. Due to their mostly low shunt volume they are rarely life threatening, but without treatment they may cause severe o cular complications like episcleral secondary glaucoma, central vein occlus ion or exudative retinal detachment. Traditional therapy is the transarteri al approach by an interventional neuroradiologist. If such an approach is n ot possible or unsuccessful a transvenous route has to be considered. Patients and methods: Two patients underwent anterior orbitotomy via sub br ow incision or infraciliary incision with cannulation of the superior ophth almic vein or the inferior ophthalmic Vein and embolization of the cavernou s sinus with platinum coils. Results: Successful closure was achieved on angiography and normalisation o f clinical symptoms after a short period of progressive venous congestion. Conclusions: For arteriovenous fistulas that cannot be embolized arterially the surgical transvenous orbital route may work as a method of second choi ce. When performed by an interdisciplinary team (orbital surgeon, intervent ionell neuroradiologist) it is a technically straightforward, effective and promising approach.