Article Text

Download PDFPDF
Case report
Robotic-guided direct transtemporal embolization of an indirect carotid cavernous fistula
  1. Patrick J Karas1,
  2. Jae Eun Lee2,
  3. Thomas S Frank1,
  4. Frances Tiffany Morden3,
  5. Hashem Shaltoni4,
  6. Peter Kan1
  1. 1 Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  2. 2 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  3. 3 Department of Neurosurgery, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
  4. 4 Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA; ptkan{at}


A middle-aged patient presented with right-sided chemosis, exophthalmos, and progressive visual loss. Digital subtraction angiography revealed a type D carotid-cavernous fistula (CCF). Transarterial embolization through the internal maxillary artery was unsuccessful, and there was no venous access to the CCF. A robotic-guided direct transtemporal embolization of the CCF with Onyx was performed, resulting in successful fistula obliteration and symptom resolution. This is the first reported case of a robotic-guided direct transcranial CCF embolization. We include a technical video that demonstrates this procedure (Supplemental File 1)

  • Balloon
  • Fistula
  • Technique
  • Vascular Malformation
  • Liquid Embolic Material

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @PeterKa80460001

  • PJK and JEL contributed equally.

  • Contributors Conception and design: PK, PJK; interpretation and analysis of manuscript: all authors; video editing: JEL; writing, editing, and approval of manuscript: all authors; study supervision: PK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.