Coiling of a carotid cavernous sinus fistula via microsurgical venotomy: recommendation of a combined neurosurgical and endovascular approach
- 1Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
- 2Department of Radiology, Division of Neuroradiology, Heinrich-Heine-University, Düsseldorf, Germany
- Correspondence to Dr Hi-Jae Heiroth, Department of Neurosurgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf D-40225, Germany;
Contributors H-JH gave final approval of the submitted manuscript and takes responsibility for the whole content.
- Received 21 November 2011
- Revised 8 January 2012
- Accepted 12 January 2012
- Published Online First 27 January 2012
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
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.