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Case report
Coiling of a carotid cavernous sinus fistula via microsurgical venotomy: recommendation of a combined neurosurgical and endovascular approach
  1. Hi-Jae Heiroth1,
  2. Bernd Turowski2,
  3. Nima Etminan1,
  4. Hans-Jakob Steiger1,
  5. Daniel Hänggi1
  1. 1Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
  2. 2Department of Radiology, Division of Neuroradiology, Heinrich-Heine-University, Düsseldorf, Germany
  1. Correspondence to Dr Hi-Jae Heiroth, Department of Neurosurgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf D-40225, Germany; hi-jae.heiroth{at}uni-duesseldorf.de

Abstract

Introduction Endovascular treatment of a carotid cavernous fistula (CCF) via a transvenous approach is standard but, in rare cases, the standard approach is not feasible due to vessel occlusion or anomalies. In such cases it remains a challenge to find an alternative route for complete treatment.

Clinical presentation A 42-year-old patient presented with a symptomatic CCF (Barrow type C). An endovascular approach to the CCF was not possible due to abnormal venous vessel architecture, so a combined surgical and interventional approach was undertaken. A custom-tailored craniotomy was first performed to access the major sylvian vein. After venotomy and insertion of a microcatheter, the CCF was completely occluded by coiling and embolization conventionally. The symptoms regressed and had almost completely disappeared at follow-up.

Conclusions An individually tailored strategy with a combined surgical and endovascular approach enabled full treatment with minimal risk for the patient.

  • Combined endovascular-neurosurgical treatment
  • carotid cavernous fistula
  • angiography
  • catheter
  • technique

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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