J Korean Ophthalmol Soc.  2006 Jul;47(7):1141-1148.

Coil Embolization Via a Superior Ophthalmic Vein Approach of Carotid Cavernous Sinus Fistula

• Lim NK
• Kim JK
• Kim EJ
• Yoo JM

Abstract

PURPOSE: The result of embolization via an external superior ophthalmic vein approach of carotid cavernous sinus fistula was first described around 1970s. We report a case of coil embolization of carotid cavernous sinus fistula using a superior ophthalmic vein approach.
METHODS
A 70-year-old female had a 3-month history of headache, periocular pain, and diplopia. Diagnostic orbital contrast-enhanced CT, brain MRI and contrast-angiography and cerebral angiography revealed a carotid cavernous sinus fistula. Fistula occlusion via transfemoral endovascular embolization failed, so we then tried coil embolization using an external superior ophthalmic vein approach of carotid cavernous sinus fistula.
RESULTS
The coil embolization via an external superior ophthalmic vein approach was difficult because of venous tortuosity and poor exposure of part of orbital roof area. But, X-ray-guided direct puncture of the superior ophthalmic vein was successful. We thus had good results with coil embolization of carotid cavernous fistula.
CONCLUSIONS
The coil embolization via superior ophthalmic vein approach is an effective and challengeable treatment when surgical cauterization or conventional endovascular embolization fails. We suggest that there is need to training ophthalmologists to be experienced in external orbital surgery.

Keyword

Carotid cavernous sinus fistula; Coil embolization; Superior ophthalmic vein approach

MeSH Terms

Aged
Brain
Carotid-Cavernous Sinus Fistula*
Cautery
Cerebral Angiography
Diplopia
Embolization, Therapeutic*
Female
Fistula
Headache
Humans
Magnetic Resonance Imaging
Orbit
Punctures
Tomography, X-Ray Computed
Veins*