98th Annual Meeting DOG 2000

K 378

Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

T. Klink1, E. Hofmann2, W. E. Lieb1

Introduction : T reatment of choice for symptomatic carotid- cavernous and cavernous-dural fistulas is a transfemoral arterial neuroradiological intervention. Due to the location of the fistula and/or to anatomic variations a direct surgical approach via the superior ophthalmic vein may be necessary for embolization.

Patients and methods: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement and secondary glaucoma. One patient has had a visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula could be confirmed in two cases by color doppler imaging and in all three cases with cerebral angiography

(2 carotid- cavernous fistulas, 1 cavernous-dural fistula). After an unsuccessful transarterial attempt an embolization via the superior ophthalmic vein was chosen.

Results: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by a transfemoral venous approach. All three patients had complete resolution of symptoms. There are no recurrences yet.

Conclusions: Embolization of carotid- cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein is safe and effective treatment, when standard transarterial access is impossible.

1Universitäts-Augenklinik, 2Abteilung für Neuroradiologie, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany


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