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Onyx Embolization of Carotid-Cavernous Fistulas and Its Impact on Intraocular Pressure and Recurrence: A Case Series.
Al Saiegh, Fadi; Baldassari, Michael P; Sweid, Ahmad; Bilyk, Jurij; Mouchtouris, Nikolaos; Hafazalla, Karim; Abendroth, Michael; Velagapudi, Lohit; Khanna, Omaditya; Chalouhi, Nohra; Sajja, Kalyan; Tjoumakaris, Stavropoula; Gooch, M Reid; Rosenwasser, Robert; Jabbour, Pascal.
  • Al Saiegh F; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Baldassari MP; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Sweid A; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Bilyk J; Wills Eye Hospital, Philadelphia, Pennsylvania.
  • Mouchtouris N; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Hafazalla K; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Abendroth M; Wills Eye Hospital, Philadelphia, Pennsylvania.
  • Velagapudi L; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Khanna O; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Chalouhi N; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Sajja K; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Tjoumakaris S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Gooch MR; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Rosenwasser R; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • Jabbour P; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Oper Neurosurg (Hagerstown) ; 20(2): 174-182, 2021 01 13.
Article in English | MEDLINE | ID: covidwho-1455340
Semantic information from SemMedBD (by NLM)
1. IMPACT gene CAUSES Raised intraocular pressure (finding)
Subject
IMPACT gene
Predicate
CAUSES
Object
Raised intraocular pressure (finding)
2. Embolizatio TREATS C0238045
Subject
Embolizatio
Predicate
TREATS
Object
C0238045
3. Embolizatio TREATS C0009081
Subject
Embolizatio
Predicate
TREATS
Object
C0009081
4. Health care facility LOCATION_OF Tonometry
Subject
Health care facility
Predicate
LOCATION_OF
Object
Tonometry
5. IMPACT gene CAUSES Raised intraocular pressure (finding)
Subject
IMPACT gene
Predicate
CAUSES
Object
Raised intraocular pressure (finding)
6. Embolization, Therapeutic TREATS Carotid-Cavernous Sinus Fistula
Subject
Embolization, Therapeutic
Predicate
TREATS
Object
Carotid-Cavernous Sinus Fistula
7. Embolization, Therapeutic TREATS Congenital clubfoot
Subject
Embolization, Therapeutic
Predicate
TREATS
Object
Congenital clubfoot
8. Health care facility LOCATION_OF Tonometry
Subject
Health care facility
Predicate
LOCATION_OF
Object
Tonometry
ABSTRACT

BACKGROUND:

Carotid-cavernous fistulas (CCFs) are acquired pathological shunting lesions between the carotid artery and the cavernous sinus leading to elevated intraocular pressure (IOP). CCFs are commonly treated via endovascular embolization, which theoretically restores physiological pressure differentials.

OBJECTIVE:

To present our institutional data with CCF treated with embolization and discuss endovascular routes, recurrence rates, and dynamic IOP changes.

METHODS:

Retrospective analysis of 42 CCF patients who underwent Onyx (Covidien, Irvine, California) embolization and pre- and postoperative IOP measurement at a single institution.

RESULTS:

CCFs were 19.0% direct (type A) and 81.0% indirect (types B, C, or D). Onyx-18 liquid embolisate was used during all embolizations. Overall rate of total occlusion was 83.3% and was statistically similar between direct and indirect fistulas. Preoperative IOP was elevated in 37.5%, 100.0%, 75.0%, and 50% in type A, B, C, and D fistulas, respectively. Average ΔIOP was -7.3 ± 8.5 mmHg (range -33 to +8). Follow-up time was 4.64 ± 7.62 mo. Full angiographic occlusion was a predictor of symptom resolution at 1 mo (P = .026) and 6 mo (P = .021). Partial occlusion was associated with persistent symptoms postoperatively at 1 mo (P = .038) and 6 mo follow-up (P = .012). Beyond 6 mo, negative ΔIOP was associated with continued symptom improvement. Recurrence occurred in 9.5% of patients, all of which were indirect CCFs.

CONCLUSION:

Onyx embolization of CCF is an effective treatment for CCF and often results in the reversal of IOP elevation. Full occlusion predicts favorable clinical outcomes up to 6 mo. Postoperative IOP reduction may indicate favorable long-term clinical outcomes.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cavernous Sinus / Carotid-Cavernous Sinus Fistula / Embolization, Therapeutic Type of study: Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Oper Neurosurg (Hagerstown) Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cavernous Sinus / Carotid-Cavernous Sinus Fistula / Embolization, Therapeutic Type of study: Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Oper Neurosurg (Hagerstown) Year: 2021 Document Type: Article