Transvenous Onyx Embolization of a Type D Carotid-Cavernous-Fistula: Operative Video.
World Neurosurg
; 156: 11, 2021 12.
Article
in English
| MEDLINE | ID: covidwho-1454571
ABSTRACT
Carotid-cavernous fistulas (CCFs) are acquired pathologic shunts between the carotid circulation and the cavernous sinus that result in venous congestion.1 They often present with ocular symptoms, such as chemosis, proptosis, and blurry vision. Cranial nerve deficits and increased intraocular pressure are often seen on the neuro-ophthalmologic examination.2 If left untreated, they can lead to cortical venous reflux and intracranial hemorrhage. A cerebral angiogram is the gold standard to diagnose these lesions. The hallmark of dural CCF is opacification of venous structures in the arterial phase of the angiogram. Dependent on carotid branches contributing to the fistula, 4 types are classically defined by Barrow et al.3 When the fistula is indirect (types B-D), the goal of treatment is obliteration via the transvenous route.4 We present the case of a patient who had chemosis and proptosis of the left eye with imaging findings concerning for dural CCF (Video 1). An informed consent was obtained and the patient underwent a cerebral angiogram and treatment of the CCF. In the operative video, we showcase the treatment of a type D CCF using transvenous embolization with Onyx (Covidien, Irvine, CA) and achieve angiographic cure of the fistula. We were able to use Onyx for embolization since the superselective injection did not show cortical venous drainage. This is important as obliteration of cortical veins with liquid embolisate could cause venous infarcts. To our knowledge, this is the first video article that illustrates the endovascular embolization of a CCF and highlights the angiographic findings pre- and post-embolization.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Polyvinyls
/
Dimethyl Sulfoxide
/
Carotid-Cavernous Sinus Fistula
/
Embolization, Therapeutic
Type of study:
Case report
/
Experimental Studies
Topics:
Long Covid
Limits:
Humans
/
Middle aged
Language:
English
Journal:
World Neurosurg
Journal subject:
Neurosurgery
Year:
2021
Document Type:
Article
Affiliation country:
J.wneu.2021.08.107
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