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Salvage transorbital approach for the endovascular treatment of carotid cavernous fistulas

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Abstract

Purpose

Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus (CS) and carotid arteries. In direct CCFs, a transarterial route is often the preferred vascular access; in case of indirect CCFs, the complex anatomy of the feeder vessels and their extra-intracranial anastomosis makes the transarterial embolization challenging and often ineffective. The aim of this study was to review our experience with the transorbital approach to treat patients affected by CCF who have already experienced an endovascular failure procedure, in order to assess this salvage technique feasibility, by analyzing possible risks and complications.

Methods

We performed a retrospective study of all patients affected by CCFs who underwent transorbital embolization between February 2017 and February 2019 at our institution.

Results

All patients (3 cases) tolerated both the retrograde embolization and the direct surgical approach with clinical improvement; the closure of the fistula was complete and verified intraoperatively by angiography. Esthetic result was acceptable in all cases with reduction of the proptosis and the intraocular pressure, and increased visual acuity. There were no complications or clinical recurrence.

Conclusion

Transorbital approach for the endovascular treatment of CCFs is a feasible and safe salvage procedure, which can find indication after other endovascular access failures.

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Authors and Affiliations

  1. Unit of Maxillofacial Surgery, IRCCS San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Francesco Arcuri

  2. Casa Di Cura San Paolo, Via del Quadrifoglio, 3, 51100, Pistoia, Italy

    Tommaso Agostini

  3. Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy

    Nicola Limbucci, Antonio Laiso, Salvatore Mangiafico & Sergio Nappini

  4. Unit of Maxillofacial Surgery, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy

    Giuseppe Spinelli & Irene Panisi

Authors
  1. Francesco Arcuri
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  2. Tommaso Agostini
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  3. Nicola Limbucci
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  4. Antonio Laiso
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  5. Salvatore Mangiafico
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  6. Giuseppe Spinelli
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  7. Irene Panisi
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  8. Sergio Nappini
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Corresponding author

Correspondence to Francesco Arcuri.

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Ethics approval and consent to participate

This study was conducted in accordance with the current revision of the Declaration of Helsinki. Informed written consent form was obtained from all patients. Current standards of scientific research ethics were applied in the performance of this retrospective study. This study has never been presented at any meetings.

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There is absence of conflict of interest.

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Arcuri, F., Agostini, T., Limbucci, N. et al. Salvage transorbital approach for the endovascular treatment of carotid cavernous fistulas. Oral Maxillofac Surg 26, 45–51 (2022). https://doi.org/10.1007/s10006-021-00961-z

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  • DOI: https://doi.org/10.1007/s10006-021-00961-z

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