Percutaneous transorbital embolization of a carotid cavernous fistula

This case report highlights utilization of image-guided, percutaneous transorbital direct cavernous sinus puncture to embolize an anteriorly draining carotid cavernous fistula (CCF) when conventional transarterial and transvenous approaches were not feasible. An 86-year-old man with a known posterio...

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Bibliographic Details
Published in:Proceedings - Baylor University. Medical Center 2019-07, Vol.32 (3), p.382-384
Main Authors: Lyons, Lance J, Smith, Sarah A, Diaz, Orlando, Diaz, Humberto, Vickers, Aroucha, Prospero, Claudia, Lee, Andrew G
Format: Article
Language:English
Subjects:
Case Reports
Embolization
Fistula
Medical imaging
Pain
Sinuses
Veins & arteries
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Summary:This case report highlights utilization of image-guided, percutaneous transorbital direct cavernous sinus puncture to embolize an anteriorly draining carotid cavernous fistula (CCF) when conventional transarterial and transvenous approaches were not feasible. An 86-year-old man with a known posterior draining CCF developed acute unilateral proptosis, pain, and vision loss ("red-eyed shunt"). Cerebral angiogram revealed the dural CCF to be draining anteriorly into partially thrombosed ophthalmic veins. After failed transarterial and transvenous attempts, a percutaneous transorbital approach was used to successfully embolize the fistula using the Onyx Liquid Embolic System according to the visual needle path generated by the Seimens Syngo iGuide. To our knowledge, this is the first reported case of percutaneous transorbital direct embolization of a CCF utilizing the Seimens Syngo iGuide.
ISSN:0899-8280
1525-3252
DOI:10.1080/08998280.2019.1596502