Imaging-Guided Superior Ophthalmic Vein Access For Embolization Of Dural Carotid Cavernous Fistulas: Report Of 20 Cases And Review Of The Literature

In this retrospective study of 20 patients, the authors report the results of imaging-guided percutaneous superior ophthalmic vein access in dural carotid cavernous fistula treatment. Minimally invasive percutaneous imaging-guided access to the SOV can be obtained in situations in which conventional transvenousaccess to the cavernous sinus is not possible for managementof patients with dural carotid cavernous fistula. The authors conclude that direct imaging-guidedpercutaneous SOV access is a valuable and time-savingalternative route compared with direct surgical SOV access.SUMMARY: Dural carotid cavernous fistulas are usually treated via a transvenous approach through the inferior petrosal sinus. Surgical exposure and direct access to the superior ophthalmic vein have been previously described in situations in which conventional transvenous access, including the inferior petrosal sinus, is not possible. In this retrospective study of 20 patients, we report our results of imaging-guided percutaneous superior ophthalmic vein access in dural carotid cavernous fistula treatment. The superior ophthalmic vein was accessed after direct percutaneous puncture under sonographic guidance in 16 patients and biplane roadmap guidance in 4 patients. In all 20 patients, it was possible to access the superior ophthalmic vein and cure the dural carotid cavernous fistula. Two patients developed a retrobulbar hematoma after postseptal puncture, which required emergency lateral canthothomy. In our experience, direct imaging-guided percutaneous superior ophthalmic vein access is a safe alternative approach for treatment in situations in which conventional transvenous approaches are not possible.