J Korean Cleft Palate-Craniofac Assoc.  2010 Oct;11(2):116-119.

Treatment of a Carotid-Cavernous Sinus Fistula via the Superior Ophthalmic Vein Approach: A Case Report

• Moon IS
• Shin HK
• Kim DI

Abstract

PURPOSE
Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach.
METHODS
A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach.
RESULTS
The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications.
CONCLUSION
Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.

Keyword

Carotid-cavernous sinus fistula; Superior ophthalmic vein; Embolization

MeSH Terms

Arteriovenous Fistula
Brain
Carotid-Cavernous Sinus Fistula
Cavernous Sinus
Cerebral Angiography
Diplopia
Estrogens, Conjugated (USP)
Female
Fistula
Follow-Up Studies
Humans
Orbit
Veins
Estrogens, Conjugated (USP)