Embolisation of sinus cavernosus fistulas via transorbital approach of the ophtalmic vein

Background The Sinus cavernosus fistula is a vascular malformation, meaning an abnormal connection between the arteria carotis interna or externa with the sinus cavernosus. Established Methods to obturate such fistulas are at the moment the comparatively risky transtemporal neurosurgical approach, or the catheter assisted transfemoral approach, which often shows an unsuccesful embolization of the sinus cavernosus fistulas. In the following, the transorbital approach with cannulating the superior ophthalmic vein and subsequently embolization of the fistula is shown in the second largest published case series so far.

Methods In total 10 patients were retrospectively analysed. Because of suspicious clinical symptomes an MRI scan of the brain was executed, as well as MR angiography in 5 cases In all 10 cases an angiography and also a cannulation of the superior ophthalmic vein was performed. A following embolisation was accomplished in 9 cases.

Results A succesful transorbital approach with cannulating the superior ophthalmic vein worked out in all 10 cases. In 9 cases a catheterization with a partial or complete embolization of the sinus cavernosus fistula could be achieved. One case showed a spontaneous vascular thrombosis. Postoperative complications occured just in one case of a multimorbid woman.

Conclusion The transorbital approach with cannulating the superior ophthalmic vein is a good alternative in comparison to the transtemporal neurosurgical exposition, if embolization via transfemoral catheterization is unsuccessfull. The new surgical methHomod shows in relation to the neurosurgical operation less invasivity with fewer possible complications and less operative expense.

Poster-PDF A-1274.PDF

Publication History

Article published online:
10 June 2020