Endovascular Treatment of Indirect Carotid‑ Cavernous Fistula Using Surgical Approach via Superior Ophthalmic Vein

Authors: D. Krahulík 1;  M. Vaverka 1;  M. Köcher 2;  M. Černá 2
Authors‘ workplace: LF UP a FN Olomouc Neurochirurgická klinika 1;  LF UP a FN Olomouc Radiologická klinika 2
Published in: Cesk Slov Neurol N 2013; 76/109(4): 482-485
Category: Short Communication


Endovascular embolisation is the preferred treatment for carotid-cavernous fistulas. However, tortuosity, hypoplasia, or stenosis of the normal venous routes may result in failure to catheterize the cavernous sinus. In these cases, direct surgical cannulation of the arterialized superior ophthalmic vein offers an excellent alternative approach.

Key words:
carotid-cavernous fistula – superior ophthalmic vein – endovascular treatment


1. Berlis A, Klisch J, Spetzger U, Faist M, Shumacher M.Carotid cavernous fistula: embolization via a bilateral superior ophthalmic vein approach. AJNR Am J Neuroradiol 2002; 23(10): 1736– 1738.

2. Wolfe SQ, Cumberbatch NM, Aziz‑ Sultan MA, Tummala R, Morcos JJ. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery 2010; 66 (Suppl 6): 293– 299.

3. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid‑ cavernous sinus fistulas. J Neurosurg 1985; 62(2): 248– 256.

4. Meyers PM, Halbach VV, Dowd CF, Lempert TE, Malek AM, Phatouros CC et al. Dural carotid cavernous fistula: definitive endovascular management and long‑term follow‑up. Am J Ophthalmol2002; 134(1): 85– 92.

5. Hamby WB. Carotid‑ cavernous fistula: report of 32 surgically treated cases and suggestions for definitive operation. J Neurosurg 1964; 21: 859– 866.

6. Parkinson D. Collateral circulation of cavernous carotid artery: anatomy. Can J Surg 1964; 7: 251– 268.

7. Klisch J, Huppertz HJ, Spetzger U, Hetzel A, Seeger W, Schumacher M. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature. Neurosurgery 2003; 53(4): 836– 857.

8. Goldberg RA, Goldey SH, Duckwiler G, Vineula F. Management of cavernous sinus‑ dural fistulas: indications and techniques for primary embolization via the superior ophthalmic vein. Arch Ophthalmol 1996; 114(6): 707– 714.

9. Halbach VV, Higashida RT, Hieshima GB, Reicher M,Norman D, Newton TH. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 1987; 163(2): 437– 442.

10. Ng PP, Higashida RT, Cullen S, Malek R, Halbach VV,Dowd CF. Endovascular strategies for carotid cavernous and intracerebral dural arteriovenous fistulas. Neurosurg Focus 2003; 15(4): ECP1.

11. Locke CE. Intracranial arterio‑ venous aneurysm or pulsating exophthalmos. Ann Surg 1924; 80(1): 1– 24.

12. Dandy WE. The treatment of carotid cavernous arteriovenous aneurysms. Ann Surg 1935; 102(5): 916– 926.

13. Parkinson D. Transcavernous repair of carotid cavernous fistula: case report. J Neurosurg 1967; 26(4): 420– 424.

14. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 1974; 41(2): 125– 145.

15. Debrun G, Lacour P, Vineula F, Fox A, Drake CG, Caron JP. Treatment of 54 traumatic carotid‑ cavernous fistulas. J Neurosurg 1981; 55(5): 678– 692.

16. Bulsara KR, Vasudevan R, Erdem E. Superior ophthalmic vein approach to carotidcavernous fistulas: technical note. Neurosurg Focus 2005; 18(2): ECP3.

17. Lee JW, Kim DJ, Jung JY, Kim SH, Huh SK, Suh SH et al. Embolisation of indirect carotid‑ cavernous sinus duralarterio‑ venous fistulae using the direct superior ophthalmic vein approach. Acta Neurochir (Wien) 2008; 150(6): 557– 561.

18. Miller NR, Monsein LH, Debrun GM, Tamargo RJ, Nauta HJ. Treatment of carotid‑ cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 1995; 83(5): 838– 842.

19. Bytton L, Hejcmanová D, Krajina A, Langrová H. An indirect carotid‑ cavernous fistula complicated by secondary glaucoma. Case report. Cesk Slov Oftalmol 2001; 57(5): 309– 314.

20. Devoto MH, Egbert JE, Tomsick TA, Kulwin DR. Acute exophthalmos during treatment of a cavernous sinus‑ dural fistula through the superior ophthalmic vein. Arch Ophthalmol 1997; 115(6): 823– 824.

21. Fukami T, Isozumi T, Shiino A, Nakazawa T, Matsuda M, Handa J. Central retinal vein occlusion after embolization for spontaneous carotid cavernous sinus fistula. No Shinkei Geka 1996; 24(8): 749– 753.

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