Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach
| Autor: | Santiago Gomez-Paz, Matt Robinson, Ajith J. Thomas, Christopher S. Ogilvy, Kimberly P. Kicielinski, David Vergara-Garcia |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Fistula Veins 03 medical and health sciences Carotid-Cavernous Sinus Fistula 0302 clinical medicine medicine Humans Vein Carotid-cavernous fistula business.industry Middle Aged medicine.disease Embolization Therapeutic Venous Valves Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Cavernous sinus cardiovascular system Female Neurology (clinical) business 030217 neurology & neurosurgery Vascular Fistula External jugular vein |
| Zdroj: | World Neurosurgery. 131:196 |
| ISSN: | 1878-8750 |
| Popis: | Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facial-angular-supraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared. |
| Databáze: | OpenAIRE |
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