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Case report
Coiling of a carotid cavernous sinus fistula via microsurgical venotomy: recommendation of a combined neurosurgical and endovascular approach


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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