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S.A. Newman, M.L. Jensen, A.J. Evans; Ophthalmic Manifestations in Patients Undergoing Trans–Orbital Percutaneous Embolization of the Cavernous Sinus for Carotid Cavernous Fistulae . Invest. Ophthalmol. Vis. Sci. 2006;47(13):782.
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Carotid cavernous fistulae often present with orbital and ophthalmic findings including decreased vision, proptosis, glaucoma, and motility problems. GDC coil embolization of the cavernous sinus can shut off the fistula and result in improvement in the patient’s neuro–ophthalmic findings. Transvenous access is most commonly accomplished through the inferior petrosal sinus. When this is not possible a direct approach may be selected through a dilated superior ophthalmic vein. In rare cases the superior ophthalmic vein is atretic anteriorly making anterior access difficult.
A case series of 2 patients with no anterior or posterior access to carotid cavernous fistulae who underwent percutaneous catheterization of the superior ophthalmic vein in the orbital apex with subsequent GDC embolization. We quantitively studied the afferent and efferent function following embolization.
Both patients (age 71 & 62) presented with double vision due to a combination of ophthalmoplegia and local orbital restriction. Other findings included chemosis, injection, and increased intraocular pressure. Angiography confirmed the presence of a carotid cavernous fistula with narrowing of the superior ophthalmic vein anteriorly and absent access through the inferior petrosal sinus. Percutaneous embolization resulted in improvement in ocular motility, resolution of chemosis, and decrease in intraocular pressure in both patients. There was no evidence of intraorbital hemorrhage.
Percutaneous access to the cavernous sinus may be possible by cannulating the superior ophthalmic vein in the orbital apex. This technique may safely expand the treatment armamentarium in patients with unusual forms of carotid cavernous fistulae.
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