J Cerebrovasc Endovasc Neurosurg.  2019 Jun;21(2):101-106. 10.7461/jcen.2019.21.2.101.

Transvenous Embolization of Dural Carotid Cavernous Fistula through the Supraorbital Vein

• Han W
• Kim JH
• Kang HI
• Kim DR
• Moon BG
• Kim JS

• KMID: 2465203
• DOI: http://doi.org/10.7461/jcen.2019.21.2.101

Abstract

We describe a case of transvenous embolization through the dilated supraorbital vein to treat a dural carotid cavernous fistula. The approach through the common facial vein or direct access of the superior ophthalmic vein is a commonly used route to the superior ophthalmic vein when the approach via the inferior petrosal sinus is unavailable. In rare cases, the dilated supraorbital vein provides an alternative route and we discuss the technical details.

Keyword

dural carotid cavernous fistula; supraorbital vein; transvenous embolization

MeSH Terms

Fistula*
Veins*

Figure

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  Fig. 1 (A) Brain computed tomographic scan showing proptosis of the left eye ball and engorged left superior ophthalmic vein (arrow). (B, C) Left internal carotid artery and external carotid artery angiogram showing a dural carotid cavernous fistula fed by branches of the left internal carotid artery and branches of the deep temporal artery and the internal maxillary artery drained into the cavernous sinus, the superior ophthalmic vein, the common facial vein, the suprorbital vein and the external jugular vein, subsequently. (D) Venous phase of the left external carotid artery angiogram showing the venous architecture of the presented case.

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  Fig. 2 (A, B) Plain x-rays showing a microcatheter (single arrow) within the cavernous sinus, a distal access catheter (double arrow) at the junction of the supraorbital vein and the angular vein, and a guiding catheter (arrow head) at the junction of the supraorbital vein and the frontal branch of the superficial temporal vein. (C, D) Immediate post-embolization angiogram of the left external carotid artery showing subtotal occlusion of the dural carotid cavernous fistula.

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  Fig. 3 (A, B) Left external carotid artery angiogram after 3 months showing small fistula fed by the middle meningeal artery. (C, D) Left external carotid artery angiogram after 8 months showing a complete occlusion of dural carotid cavernous fistula.

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