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Abstract #15752 Published in IGR 2-3
Surgical transvenous embolization of spontaneous carotid cavernous sinus fistulas in two patients
Schmidbauer JM; Voges M; Hagen T; Ruprecht KWKlinische Monatsblätter für Augenheilkunde 2000; 217: 240-245
BACKGROUND: Arteriovenous communications in which blood flows from the meningeal branches of the internal and external carotid arteries into the venous circulation around and in the cavernous sinus are termed spontaneous (dural) carotid sinus cavernous fistulas. Due to their mostly low shunt volume, they are rarely life threatening but, without treatment, they may cause severe ocular complications such as episcleral secondary glaucoma, central vein occlusion, or exudative retinal detachment. Traditional therapy is the transarterial approach by an interventional neuroradiologist. If such an approach is not possible or unsuccessful, a transvenous route should be considered. PATIENTS AND METHODS: Two patients underwent anterior orbitotomy via sub-brow or infraciliary incision with cannulation of the superior ophthalmic vein or the inferior ophthalmic vein, and embolization of the cavernous sinus with platinum coils. RESULTS: Successful closure was achieved on angiography and normalization of the clinical symptoms after a short period of progressive venous congestion. CONCLUSIONS: For arteriovenous fistulas that cannot be embolized arterially, the surgical transvenous orbital route may work as a method of second choice. When performed by an interdisciplinary team (orbital surgeon, interventional neuroradiologist), it is a technically straight forward, effective and promising approach.LA: German
Dr. J.M. Schmidbauer, Augenklinik mit Poliklinik, Universitäts-Augenklinik, Homburg, Saar, Germany
Classification:
9.4.9 Glaucomas associated with elevated episcleral venous pressure (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
