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Transorbital Puncture for the Treatment of Cavernous Sinus Dural Arteriovenous Fistulas.

Kennith Franklin LAYTON
Kennith Franklin LAYTON MD
Texas, Dallas
Radiology
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* Date : 06-08-2009 - 07:16 PM (5407 days ago),

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Transorbital Puncture for the Treatment of Cavernous Sinus Dural Arteriovenous Fistulas.

Carotid cavernous fistulas (CCFs) are arteriovenous shunts that are fed by the external carotid artery, the internal carotid artery (ICA), or both and drain by way of the cavernous sinus and its tributaries. The surgical treatment of cavernous sinus dural arteriovenous fistulas (DAVFs) is technically difficult and associated with significant morbidity.1,2 As such, endovascular embolization via a transvenous approach has become a mainstay of treatment.3 Numerous transvenous approaches have been described, with most practitioners preferring a transfemoral access.4 However, when the veins are not traversable from a transfemoral route, many have advocated a surgical exposure of the superior ophthalmic vein followed by direct catheterization of the exposed vein.4

An alternative approach for endovascular treatment is through a direct transorbital puncture of the cavernous sinus or indirectly via the inferior ophthalmic vein (IOV). We are aware of only 1 other account in the literature that describes an IOV approach.5 The purpose of this report is to describe the successful embolization of a series of patients with CCFs by using a direct transorbital cavernous sinus or IOV puncture to treat fistulas. We have found that that this approach is safe and technically straightforward while providing a useful alternative to other transvenous routes.

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