Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical note

Author:

Abaunza-Camacho Juan Felipe12ORCID,Vergara-Garcia David12ORCID,Madrinan-Navia Humberto12,Riveros William Mauricio12,Caballero Alberto12

Affiliation:

1. Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia

2. Rosario University School of Medicine, Bogotá, Colombia

Abstract

Abstract Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required. Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR). Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution. Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.

Publisher

Georg Thieme Verlag KG

Subject

Neurology (clinical),Surgery

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