Abstract
We give a preliminary report of theophthalmologic outcome offour patients with transvenousembolization studied for their spontaneouscarotid-cavernous fistulas. One ofthem is a direct type while threeof them are indirect dural shunts. Inindirect dural shunts, traditionaltransarterial embolization rarelyachieves a complete clinical cure in ashort period of time. All caseshad an ophthalmologic disturbancejustified for endovascularintervention. We performed catheterization,and subsequently embolization withGuglielmi Detachable coils, tothe cavernous sinus via the femoralvein and inferior petrosal sinus/superiorophthalmic vein. All fourpatients achieved clinical andangiographic improvement with afollow-up period range from twoto sixteen months except for onepatient who had residual bilateralsixth nerve palsy. The transvenousapproach offers an effective andsafe alternative for the management ofspontaneous carotid-cavernous fistula.
Similar content being viewed by others
References
Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous fistulas. J Neurosurg 1985;62:248–256.
Kupersmith MJ, Berenstein A, Flamm E, Ransohoff J. Neuroophthalmologic abnormalities and intravascular therapy of traumatic carotid-cavernous fistulas. Ophthalmology 1985;93:906–912.
Kurata A, Miyasaka Y, Kunii M, Nagai S, Ohmomo T, Morishima H, Fujii K, Kan S. The value of long-term clinical follow-up for cases of spontaneous carotid-cavernous fistula. Acta Neurochir (Wein) 1998;140:65–72.
Halbach VV, Higashida RT, Hieshima GB, Reicher M, Norman D, Neuton TH. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 1987;163:437–442.
Kupersmith MJ, Berenstein A, Choi IS, Warren F, Flamm E. Management of non-traumatic vascular shunts involving the cavernous sinus. Ophthalmology 1988;95:121–130.
Roy D, Raymond J. The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistula. Neurosurgery 1997;40:1133–1144.
Debrun G, Lacour P, Vinuela F, Fox A, Charles G, Drake G, Caron J. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 1981;55:678–692.
Goldberg RA, Goldey SH, Duckwiler G, Vineula F. Management of cavernous sinus-dural fistulas. Arch Ophthalmol 1996;114:707–714.
Hanneken AM, Miller NR, Debrun GM, Nauta H. Treatment of carotid-cavernous fistulas using a detachable ballon catheter through the superior ophthalmic vein. Arch Ophthalmol 1989;107:87–92.
King WA, Hieshima GB, Martin N. Venous rupture during transvenous approach to a carotid-cavernous sinus fistula. J Neurosurg 1989;71:133–137.
Gupta N, Kikkawa DO, Levi L, Weinreb RN. Severe visual loss and neovascular glaucoma complicating superior ophthalmic vein approach to carotid-cavernous fistula. Am J Ophthal 1997;124(6):853–855.
Miller NR et al. Treatment of carotid-cavernous fistula using a superior ophthalmic vein approach. J Neurosurg 1995;83:838–842.
Devoto M, Egberg J, Tomsick TA. Kulwin DR. Acute exophthalmos during treatment of a cavernous sinus-dural fistula through the superior ophthalmic vein. Arch Ophthalmol 1997;115:823–824.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Liang, CC., Michon, J.J., Cheng, KM. et al. Ophthalmologic outcome of transvenous embolization of spontaneous carotid-cavernous fistulas: a preliminary report. Int Ophthalmol 23, 43–47 (1999). https://doi.org/10.1023/A:1006409826007
Issue Date:
DOI: https://doi.org/10.1023/A:1006409826007