TY - JOUR
T1 - Combined transarterial, transvenous, and direct puncture of the cavernous sinus to cure a traumatic carotid cavernous fistula
AU - Lin, Chung Jung
AU - Luo, Chao Bao
AU - Chang, Feng Chi
AU - Teng, Michael Mu Huo
AU - Wang, Kao Lun
AU - Chu, Shu Hsun
PY - 2009/12
Y1 - 2009/12
N2 - Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right direct CCF. The patient underwent transarterial and transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils (GDCs), but a residual shunt persisted. Two days later, another session of embolization by direct puncture of the CS with GDCs was performed after failure to navigate through the superior ophthalmic vein which was partially occupied by previously deployed coils. Immediate control angiography showed complete obliteration of the fistula and the patient's symptoms rapidly resolved. This is the first report of a patient with a CCF who required three combined approaches - transarterial, transvenous, and direct puncture of the CS - to achieve complete closure of the complexed shunt.
AB - Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right direct CCF. The patient underwent transarterial and transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils (GDCs), but a residual shunt persisted. Two days later, another session of embolization by direct puncture of the CS with GDCs was performed after failure to navigate through the superior ophthalmic vein which was partially occupied by previously deployed coils. Immediate control angiography showed complete obliteration of the fistula and the patient's symptoms rapidly resolved. This is the first report of a patient with a CCF who required three combined approaches - transarterial, transvenous, and direct puncture of the CS - to achieve complete closure of the complexed shunt.
KW - Carotid cavernous fistula
KW - Transarterial embolization
KW - Transorbital
KW - Transvenous embolization
UR - http://www.scopus.com/inward/record.url?scp=70350712137&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2009.02.026
DO - 10.1016/j.jocn.2009.02.026
M3 - Article
C2 - 19767209
AN - SCOPUS:70350712137
SN - 0967-5868
VL - 16
SP - 1663
EP - 1665
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
IS - 12
ER -