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Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature

Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, a...

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Autores principales: Chen, Ching-Jen, Mastorakos, Panagiotis, Caruso, James P, Ding, Dale, Schmitt, Paul J, Buell, Thomas J, Raper, Daniel M, Evans, Avery, Newman, Steven A, Jensen, Mary E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298197/
https://www.ncbi.nlm.nih.gov/pubmed/28191380
http://dx.doi.org/10.7759/cureus.976
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author Chen, Ching-Jen
Mastorakos, Panagiotis
Caruso, James P
Ding, Dale
Schmitt, Paul J
Buell, Thomas J
Raper, Daniel M
Evans, Avery
Newman, Steven A
Jensen, Mary E
author_facet Chen, Ching-Jen
Mastorakos, Panagiotis
Caruso, James P
Ding, Dale
Schmitt, Paul J
Buell, Thomas J
Raper, Daniel M
Evans, Avery
Newman, Steven A
Jensen, Mary E
author_sort Chen, Ching-Jen
collection PubMed
description Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe a case example with bilateral Barrow Type B CCFs, which were inaccessible using the traditional transvenous approach. Hence, a direct transorbital approach, performed under fluoroscopic guidance, was employed to successfully obliterate the CCF. At five months follow-up, the patient was recovering without complications. This case delineates the technical aspects of transorbital CCF embolization and demonstrates that this approach is a viable alternative to conventional transvenous methods for appropriately selected CCF cases. We supplement our case example and technical note with a literature review of this approach.
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spelling pubmed-52981972017-02-10 Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature Chen, Ching-Jen Mastorakos, Panagiotis Caruso, James P Ding, Dale Schmitt, Paul J Buell, Thomas J Raper, Daniel M Evans, Avery Newman, Steven A Jensen, Mary E Cureus Radiology Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe a case example with bilateral Barrow Type B CCFs, which were inaccessible using the traditional transvenous approach. Hence, a direct transorbital approach, performed under fluoroscopic guidance, was employed to successfully obliterate the CCF. At five months follow-up, the patient was recovering without complications. This case delineates the technical aspects of transorbital CCF embolization and demonstrates that this approach is a viable alternative to conventional transvenous methods for appropriately selected CCF cases. We supplement our case example and technical note with a literature review of this approach. Cureus 2017-01-12 /pmc/articles/PMC5298197/ /pubmed/28191380 http://dx.doi.org/10.7759/cureus.976 Text en Copyright © 2017, Chen et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiology
Chen, Ching-Jen
Mastorakos, Panagiotis
Caruso, James P
Ding, Dale
Schmitt, Paul J
Buell, Thomas J
Raper, Daniel M
Evans, Avery
Newman, Steven A
Jensen, Mary E
Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title_full Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title_fullStr Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title_full_unstemmed Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title_short Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature
title_sort transorbital approach for endovascular occlusion of carotid-cavernous fistulas: technical note and review of the literature
topic Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298197/
https://www.ncbi.nlm.nih.gov/pubmed/28191380
http://dx.doi.org/10.7759/cureus.976
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