RT Journal Article
SR Electronic
T1 Direct puncture of the superior ophthalmic vein for carotid cavernous fistulas: a 21-year experience
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2022-019135
DO 10.1136/jnis-2022-019135
A1 Joshua S Catapano
A1 Visish M Srinivasan
A1 Nicole M De La Peña
A1 Rohin Singh
A1 Tyler S Cole
A1 D Andrew Wilkinson
A1 Jacob F Baranoski
A1 Caleb Rutledge
A1 Mark A Pacult
A1 Ethan A Winkler
A1 Ashutosh P Jadhav
A1 Andrew F Ducruet
A1 Felipe C Albuquerque
YR 2022
UL http://jnis.bmj.com/content/early/2022/10/19/jnis-2022-019135.abstract
AB Background Direct puncture of the superior ophthalmic vein (SOV) is an alternative approach to traversing the inferior petrosal sinus for embolization of carotid cavernous fistulas (CCFs).Objective To analyze direct SOV puncture for the treatment of CCFs and review the literature.Methods All patients at a single center, treated for a CCF with direct SOV cannulation between January 1, 2000, and December 31, 2020, were retrospectively analyzed. An additional review of the literature for all case series for direct puncture of the SOV for treatment of CCF was performed.Results During the 21-year study period, direct cannulation of the SOV for treatment of a CCF was attempted for 19 patients, with the procedure aborted for one patient because of an inability to navigate the wire into the distal aspect of the cavernous sinus. In 18 patients with direct SOV CCF treatment, 1 experienced a minor complication with an asymptomatic postoperative hemorrhage. Angiographic cure and improvement of symptoms were achieved in 17 patients with a mean (SD) follow-up of 6 (5.2) months. In the review of the literature, an additional 45 patients were reported to have direct cannulation of the SOV for CCF treatment, with angiographic cure in 43 (96%) and decreased objective visual acuity in 1 (2%).Conclusion Direct SOV cannulation to treat CCFs is safe and effective. Although it is typically used after other endovascular approaches have failed, SOV access for CCF treatment may be warranted as a first-line treatment for select patients.