Clinical case of endovascular embolization of dural carotid cavernous fistula by transvenous transorbital access

Authors

  • O.V. Petrenko Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine http://orcid.org/0000-0003-0671-8681
  • E.S. Egorova State Institution “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
  • A.G. Lugovskyy State Institution “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
  • M.Yu. Orlov State Institution “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
  • Yu.V. Chepurnoy Bogomolets National Medical University, Kyiv, Ukraine
  • Yu.R. Yarotskyi State Institution “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2309-8147.7.3.2019.179620

Keywords:

carotid cavernous fistula, transorbital access, endovascular treatment

Abstract

A clinical case of transvenous transorbital endovascular embolization of dural carotid cavernous fistulas (CCF) is presented. CCF is a complex pathology of cerebral vessels, with the formation of abnormal arterial blood flow into the cavernous sinus. An increase in pressure in the venous sinus to a level that exceeds venous pressure and reaches blood pressure leads to the stagnation in the structures from which venous blood flows normally. The first symptom of the disease is a pulsating noise in the temporal region observed in most patients with CCF. Ophthalmic symptoms are represented by signs of impaired venous outflow from the eye and orbit regardless of the source of blood supply to the CCF. In the clinical course of disease, the following ophthalmic symptoms prevail: exophthalmos, injection of the eye, eyelid edema, chemosis, oculomotor disorders, increased intraocular pressure. The prognosis of the spontaneous course of the disease with CCF is unfavo­rable. Recovery occurs in 5–10 % of cases, mortality makes up to 15 % of intracranial bleedings, 50–60 % of patients are disabled due to vision loss and mental disorders. The main method of treatment is the endovascular embolization of CCF using various methods: balloon catheters, coils, clotting liquid compositions. The transvenous access is performed through the internal jugular vein and the inferior petrosal sinus. Catheterization is not possible with inferior petrosal sinus thrombosis. The method of choice may be direct surgical puncture of the superior ophthalmic vein. The presented clinical case demonstrates embolization of the fistula by implantation of coils using transvenous transorbital access through the superior ophthalmic vein, when the traditional endovascular transvenous access cannot be administered — through the internal jugular vein and inferior petrosal sinus. Three month follow-up demonstrated normal blood flow in the cavernous sinus. The clinical case shows the importance of early diagnosis for the timely embolization of the fistula from the bloodstream in order to maintain vision function. Transvenous access through the superior ophthalmic vein for the first time was used in Ukraine.

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Published

2021-09-28

Issue

Section

Case report

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