Unilateral isolated superior ophthalmic vein thrombosis

Superior ophthalmic vein (SOV) thrombosis is an uncommon orbital pathology that can present with sudden onset proptosis, conjunctival injection, and visual disturbance. SOV thrombosis is frequently secondary to a cavernous sinus pathology. A 32-year-old female with a known history of autoimmune hemolytic anemia presented with sudden painful proptosis left eye, and on imaging, she was found to have SOV thrombosis without cavernous sinus involvement. She was diagnosed with unilateral isolated SOV thrombosis and was managed conservatively. A careful history and clinical evaluation can help diagnose such rare disorders and initiate appropriate therapy.

Fístula dural cavernosa. presentación de 3 casos y revisión bibliográfica / Cavernous dural fistula. presentation of 3 cases and bibliographic review

Objetivo: Describir la etiología, forma de presentación, evolución y conducta terapéutica adoptada en tres casos de fístulas durales cavernosas (FDC) y realizar una revisión bibliográfíca. Materiales y métodos: Se presentan tres casos de FDC, una, post-traumática; otra, secundaria a trombosis del seno cavernoso contralateral; y la tercera sin causa conocida. Todos los pacientes se presentaron con proptosis, diplopía, quemosis, ptosis palpebral e inyección conjuntival. Dos de ellos referían disminución de la agudeza visual. Ante la sospecha clínica, se realizaron estudios por imágenes no invasivos en dos pacientes, y el diagnóstico fue confirmado por angiografía digital cerebral en los tres casos. La conducta terapéutica consistió en la oclusión del seno cavernoso con coils a través de un acceso venoso femoral transoftálmico en el primer caso, anticoagulación como tratamiento de la trombosis de seno cavernoso contralateral en el segundo y compresión ocular diaria por 3 meses en el tercero. Resultados: En todos los casos, se logró la resolución completa de los síntomas. Conclusiones: La FDC es una entidad diferenciada del resto de las fístulas durales. Se dispone de diversas estrategias terapéuticas, con resultados favorables. También se observa una alta tasa de remisión espontánea. En dos de los casos presentados, el manejo de forma conservadora fue eficaz para la resolución del cuadro. En el caso que requirió tratamiento endovascular para el cierre de la fistula, el acceso por vía venosa femoral transoftálmica constituyó un abordaje efectivo para lograr la oclusión de la misma.

Objective: To describe the etiology, presentation, evolution and therapeutic approach adopted in three cases of dural cavernous fistulas (DCCF) and to perform a literature review.Materials and methods: Three cases of DCCF are report, one, post-traumatic lession; another secondary to contralateral cavernous sinus thrombosis; and the third with unknown etiology. All patients presented with proptosis, diplopia, chemosis, ptosis and conjunctival injection. Two of them concerned vision impairment. Noninvasive imaging studies were performed in two patients, and the diagnosis were confirmed by cerebral angiography digital in all three cases. The therapeutic approach consisted of cavernous sinus occlusion with coils through a femoral venous access in the first case, anticoagulation treatment of contralateral cavernous sinus thrombosis in the second and ocular compression daily for 3 months in the third. Results: Complete resolution of symptoms was achieved in all cases.Conclusions: The FDC is a distinct entity from the rest of the dural fistulas. It has several therapeutic strategies, with favorable results. A high rate of spontaneous remission is also observed. In two cases, conservative management was effective in the resolution of the picture. In the case requiring endovascular treatment for closure of the fistula, femoral vein transoftálmic acces was an effective approach to achieve occlusion of it.

Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

We present two patients with a dural arteriovenous fistula (dAVF) of the ophthalmic sheath who developed progressive exophthalmos, conjunctival chemosis, and visual loss. These symptoms mimic those of cavernous sinus dAVFs. Dural AVFs of the ophthalmic sheath are extremely rare and their clinical management is controversial. We successfully treated these two patients by transvenous coil embolization. Transvenous embolization appears to be a safe and effective method to treat dAVFs of the ophthalmic sheath.

Orbital apex osteodural fistula - An unusual surgical access.

Dural arteriovenous fistulas (DAVFs) are fistulas connecting the branches of dural arteries to dural veins or a venous sinus. Osteodural fistulas are a rare subset of this group of diseases. We wish to report a rare case of an osteodural arteriovenous fistula at the foot of the superior ophthalmic vein (SOV), treatment of which required an unusual surgical approach via the orbit and SOV. Though access for endovascular treatment via the SOV for treatment of caroticocavernous fistulas is reported, the external approach is relatively infrequently performed, outside Europe and the Americas, with this being the first reported procedure from the Indian subcontinent. We wish to explain the steps of this unusual surgical access and highlight the salient precautions and pitfalls in the technique.

Fistulas carótido cavernosa / Carotid Cavernous Fistulas

Las fistulas carotido-cavernosas son patologías vasculares relativamente infrecuentes que tiene una etiología de mayor frecuencia traumática que espontanea. Su diagnóstico no siempre es sencillo y requiere de conocer la patología para poder tener la sospecha clínica y poder brindar solución de manera rápida y minimizar secuelas. El tratamiento de las fistulas ha mejorado con el tiempo y con el advenimiento de la cirugía endovascular, con esto se han ido descubriendo mejores accesos y mecanismos para tratarlo, como lo es el abordaje por la vena oftálmica superior. Sin embargo esto no siempre es posible debido a la variaciones anatómicas que en ella se encuentran, pero cuando se logra tiene resultado cosméticos y funcionales muy adecuados.

Carotid-cavernous fistulas are relatively uncommon vascular pathologies that have a traumatic etiology mostly spontaneous. Diagnosis is not always easy and requires knowledge of pathology to clinical suspicion and have to provide a solution quickly minimizing the consequences. The treatment of the fistulas has improved with the time and with the advent of the surgery endovascular, with this have been discovered and improved access mechanisms as is the boarding across the ophthalmic top vein. Nevertheless, this not always is possible due to the anatomical variations that in her they find, but when it is achieved, there are obtained cosmetic and functional very suitable results.

Color Doppler imaging of the superior ophthalmic vein in patients with Graves' orbitopathy before and after treatment of congestive disease

OBJECTIVE: To compare superior ophthalmic vein blood flow parameters measured with color Doppler imaging in patients with congestive Graves' orbitopathy before and after treatment and in normal controls. METHODS: Twenty-two orbits from 12 patients with Graves' orbitopathy in the congestive stage and 32 orbits from 16 normal controls underwent color Doppler imaging studies. Color Doppler imaging was repeated after treatment in the group of patients with Graves' orbitopathy, which included orbital decompression in 16 orbits and corticosteroids in six orbits. The findings for each group were compared. RESULTS: In the group of orbits with congestive disease, superior ophthalmic vein flow was detected in 17 orbits (anteroposteriorally in 13 and in the opposite direction in four) and was undetectable in five. After treatment, superior ophthalmic vein flow was detected and anteroposterior in 21 and undetected in one orbit. In normals, superior ophthalmic vein flow was detected anteroposterior in 29 orbits and undetectable in three orbits, indicating a significant difference between groups. There was also a significant difference between controls and congestive Graves' orbits and between congestive orbits before and after treatment, but not between controls and patients after treatment. A comparison of superior ophthalmic vein flow parameters revealed a significant difference between the groups. The superior ophthalmic vein flow was significantly reduced in the congestive stage compared with the flow parameters following treatment and in the untreated controls. CONCLUSIONS: Superior ophthalmic vein flow was significantly reduced in the orbits affected with congestive Graves' orbitopathy and returned to normal following treatment. Congestion appears to be a contributing pathogenic factor in the active inflammatory stage of Graves' orbitopathy.

Endovascular embolotherapy treatment of carotid cavernous fistulas via superior ophthalmic vein / 中国综合临床

Objective To evaluate the effect of endovascular embolotherapy treatment of carotid cavernous fistulas(CCF) via superior ophthalmic vein(SOV).Methods From June 1996 to June 2006,a total of 32 patients(16 female) with complex CCF underwent endovascular embolotherapy treatment through the SOV.All of the patients visited doctor due to ocular signs and symptoms.Nine patients with direct CCF had previously undergone partial arterial balloons embolotherapy.The other 23 patients were hard mater CCF,and of which 3 had underwent NBCA,embolotherapy with line section or PVA particle.In the angiographic suite all patients underwent general anesthesia,SOV was catheterized through the eyebrow incision.Cavernous sinus was packed with free coils,detachable coils or balloons and NBCA.Results Complete embolism of the arteriovenous shunt was achieved in 81.3%(26/32).A minor residual shunt(without cortical or ocular drainage) remained in 12.5%(4/32).Only SOV was occluded in 6.2%(2/32).All patients were clinical improvement without complications.No death and permanent disability occurred.No recurrence was observed during follow-up of mean time of 3.5 years in 22 outpatients.Conclusion The operative approach to SOV is straightforward and several kind of embolic materials can be used to embolize the cavernous sinus.Endovascular occlusion of cavernous sinus through the SOV is an efficient and safe treatment in CCF.

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

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.

A rare case of paediatric pontine Glioblastoma presenting as a cerebellopontine angle otogenic abscess

We describe rare case of a 9-year old boy who presented with a two- week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme.

Indirect carotid-cavernous sinus fistulas treated by transvenous approach through the superior ophthalmic vein: A case report and technical note.

Objective: To present the results of our treatment of indirect carotid- cavernous sinus fistulas with surgical exposure of the superior ophthalmic vein (SOV), retrograde venous catheterization, and coil embolization of the cavernous sinus in a patient whom the standard transvenous catherization for treatment of indirect carotid–cavernous fistulas had failed. Methods: No method Results: Complete fistula obliteration was accompanied by recovery of the clinical symptoms. Conclusion: The surgical SOV approach might be sufficient when standard endovascular intervention does not succeed. The technique is safe and effective when performed by an interdisciplinary team.

Dental infection presenting with ipsilateral parapharyngeal abscess and contralateral orbital cellulitis – A case report

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.

Imaging diagnosis of superior ophthalmic vein enlargement associated with orbital arteriovenous malformation / 眼科

Objective To investigate the radiologic and angiographic findings of dilated superior ophthalmic vein(SOV)associat- ed with orbital arteriovenous malformations(AVM).Design Retrospective case series.Participants Six cases of orbital AVM patients, with clinical symptoms and signs mimicking a carotid cavernous fistula(CCF).Methods Examinations of the six cases,such as CT, MRI,and selective cerebral angiography,were summarized and analyzed.Main Outcome Measures Images findings and hemodynam- ics.Results All patients were found with dilated SOV on CT and MRI.Additional radiographic findings included proptosis and AVM. All six AVM were located at the orbit,and one of them was also found with AVM in brain.The main draining vein was SOV in all cas- es.The branches contributing to the fistula's blood supply were the middle meningeal artery,the internal maxillary artery,and the oph- thalmic artery.Conclusions Orbital AVM can cause similar clinical signs and radiologic features to those associated with a CCF.How- ever,the bulging cavernous sinus cannot be found in most AVM.Angiography is necessary for definitive management,non-invasive techniques have an important role in pre-angiographic diagnostic decisions.(Ophthalmol CHN,2007,16:395-398)

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

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.

Treatment of CCFs with facial vein-superior ophthalmic vein approaches / 介入放射学杂志

Objective To evaluate the efficacy of facial vein-superior ophthalmic vein approach to embolize carotid-cavernous sinus fistulas.Metheds The involved cavernous sinus was catheterized through the femoral vein-facial vein- superior ophthalmic vein approach, GDC, EDC, free microcoil, or silk were used to pack the sinus and occlude the shunt. If therer was any difficulty in catheterizing the faical vein, facial vein was exposed surgically and punctured, and then, through the superior opthalmic vein, the cavernous sinus was packed. Results 16 cavernous sinuses in 14 CCF patients(5 traumatic CCFs, 9 dural CCFs) were catheterized through facial vein-superior ophthalmic vein approach, and the technical success was achieved in 15 cavernous sinuses. Immediate angiographic cure of the shunts was achieved in 11cases, residual shunts with inferior petral sinus drainage in 2. Facial vein occlusion was encountered in 1 patient during the facial vein catheterization, further packing of the cavernous sinus was not performed, but follow-up angiography at the 21 st day revealed the spontaneous cure of the shunt. The VI cranial nerve palsy present after balloon embolization in a type A CCF was not improved after the packing of the cavernous sinus. Ocular symptoms in other patients disappeared after tranvenous embolization. The clinical follow-up period ranged from 3 to 21 months, no recurrence of the symptoms was found. Follow-up angiography in 2 patients with residual shunting showed the unchanged shunts, no further embolization was performed. No follow-up angiography was performed in other patients.Conclusions The facial vein-superior ophthalmic vein approach can be chosen as an optimum treatment for dural CCFs, and an important alternative treatment for type A CCFs after the failure of the initial balloon embolization.

Treatment of Indirect Carotid Cavernous Fistulas(Type D) / 대한뇌혈관학회지

OBJECTS: Type D indirect carotid cavernous fistulas(CCFs) have been known to be challenging and problematic in its treatment. We present three cases of type D indirect CCFs treated successfully by transvenous balloon embolization through the superior ophthalmic vein (SOV) and radiotherapy. MATERIAL AND METHODS: All of these patients presented with proptosis, chemosis, diplopia and elevated intraocular pressure. The duration of symptoms until treatment of the these patients was 3 months, 4 months and 4 years respectively. Of these patients, two patients were treated successfully by transvenous balloon embolization through the ipsilateral SOV into the cavernous sinus and one patient, had previously been treated unsuccessfully by transvenous embolization via the SOV, was treated by radiotherapy delivering 3600 cGy. RESULTS: All patients had complete resolution of symptoms and signs after the treatments. There were no intraoperative complication, however, two patients who were treated by transvenous embolization via the SOV had transient oculomotor nerve palsy which had improved completely later. None of the three patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 12 months to 25 months. CONCLUSION: We think that transvenous embolization through the SOV and radiotherapy can be a safe and successful means of treating type D indirect CCFs.

A Case of Superior Ophthalmic Vein Thrombosis Treated by Thrombolysis with Urokinase

The authors experienced a case of bilateral superior ophthalmic vein thrombosis diagnosed by transfemoral carotid angiography. Thrombolysis was performed by injecting urokinase directly to the obstruction site during angiography. The patient`s visual acuity recovered from light perception to 0.8 in the right eye, and 0.9 in the left eye.

GDC(Guglielmi Detachable Coil) Embolization for Carotid Cavernous Fistula - by Percutaneous Puncture of Superior Ophthalmic Vein -

OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.

Short term therapeutic effect of embolizing carotid-cavernous sinus fistula by superior ophthalmic vein approaches / 眼科

Objective To investigate the therapeutic effect of embolizing carotid-cavernous sinus fistula(CCF) by superior ophthalmic vein(SOV) approaches.Design Retrospective case series.Participants 11 patients with CCF diagnosed by digital subtraction angiography(DSA) were failurers of traditional artery approaches.Methods All pathents were treated with embolizing carotid-cavernous sinus fistula by superor ophthalmic vein approaches.Main Outcome Measures visual acuity,exophthalmos,ocular movement,diplopia,conjunctival hyperemia,ocular fundus changes.Results Clinical cure was achieved in all 11 patients during follow-up for 1 week to 3 months.Six patients with symptoms of exophthalmos disappeared and five improved.8 cases with conjunctival hyperemia vanished and 3 cases relieved.The three patients with decreases of 8 visual acuity,among these one patient was normal and two improved.Intracalvarium strepitus and diplopia were all disappeared and ocular movement was normal.Conclusion Embolizing CCF by SOV is safe and effective when performed by a multidisciplinary team.

The Etiological Diagnosis of Enlarged Superior Ophthalmic Vein with Ultrasonography and Computed Tomography / 第二军医大学学报

B-ultrasonography and/or CT scannings of 84 cases of enlarged superior ophthalmic vein (SOV) were analysed morphologically and etiologically. Carotid-cavernous fistula, ophthalmic Graves disease, Tolosa-Hunt syndrome, orbital vascular deformity, inflammation at the apex of the orbit, orbital pseudo tumor, intraorbital hematoma and thrombosis of the SOV might induce enlargement of SOV. Associated with other Findings of intraorbital tissues revealed by CT and B-ultrasonography, the etiological diagnosis of the enlarged SOV could be made. The dynamic findings of the SOV rendered by B-ultrasonography and Doppler ultrasonic play an important role in the diagnosis of carotid-cavernous fistula.