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Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach
Video Article
Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach Santiago Gomez-Paz, David Vergara-Garcia, Matt Robinson, Kimberly P. Kicielinski, Ajith J. Thomas, Christopher S. Ogilvy
Key words Carotid-cavernous sinus fistula - Coil embolization - Endovascular - Endovascular procedures - Vascular fistula -
Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA To whom correspondence should be addressed: Christopher S. Ogilvy, M.D. [E-mail: [email protected]] Supplementary digital content available online. Citation: World Neurosurg. (2019) 131:196. https://doi.org/10.1016/j.wneu.2019.08.039 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
REFERENCES 1. Ducruet AF, Albuquerque FC, Crowley RW, McDougall CG. The evolution of endovascular treatment of carotid cavernous fistulas: a singlecenter experience. World Neurosurg. 2013;80:538-548.
Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facialeangularesupraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared.
2. Thiex R, Gross BA, Gupta R, Wyers MC, Frerichs KU, Thomas AJ. Transvenous approach to carotid-cavernous fistula via facial vein cut down. J Clin Neurosci. 2014;21:1238-1240.
in a multicenter cohort. Neurosurgery. 2015;77: 380-385.
3. Leone G, Renieri L, Enriquez-Marulanda A, et al. Carotid cavernous fistulas and dural arteriovenous fistulas of the cavernous sinus: validation of a new classification according to venous drainage [e-pub ahead of print]. World Neurosurg. https://doi.org/10. 1016/j.wneu.2019.04.220, accessed May 7,2019.
5. Wolfe SQ, Cumberbatch NM, Aziz-Sultan MA, Tummala R, Morcos JJ. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery. 2010; 66(suppl 6):293-299.
4. Thomas AJ, Chua M, Fusco M, et al. Proposal of venous drainage-based classification system for carotid cavernous fistulae with validity assessment
Conflict of interest statement: The authors declare that the article content was composed in the absence of any
196
www.SCIENCEDIRECT.com
commercial or financial relationships that could be construed as a potential conflict of interest. Received 8 July 2019; accepted 7 August 2019 Citation: World Neurosurg. (2019) 131:196. https://doi.org/10.1016/j.wneu.2019.08.039 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.08.039
Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach Santiago Gomez-Paz, David Vergara-Garcia, Matt Robinson, Kimberly P. Kicielinski, Ajith J. Thomas, Christopher S. Ogilvy
Key words Carotid-cavernous sinus fistula - Coil embolization - Endovascular - Endovascular procedures - Vascular fistula -
Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA To whom correspondence should be addressed: Christopher S. Ogilvy, M.D. [E-mail: [email protected]] Supplementary digital content available online. Citation: World Neurosurg. (2019) 131:196. https://doi.org/10.1016/j.wneu.2019.08.039 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
REFERENCES 1. Ducruet AF, Albuquerque FC, Crowley RW, McDougall CG. The evolution of endovascular treatment of carotid cavernous fistulas: a singlecenter experience. World Neurosurg. 2013;80:538-548.
Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facialeangularesupraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared.
2. Thiex R, Gross BA, Gupta R, Wyers MC, Frerichs KU, Thomas AJ. Transvenous approach to carotid-cavernous fistula via facial vein cut down. J Clin Neurosci. 2014;21:1238-1240.
in a multicenter cohort. Neurosurgery. 2015;77: 380-385.
3. Leone G, Renieri L, Enriquez-Marulanda A, et al. Carotid cavernous fistulas and dural arteriovenous fistulas of the cavernous sinus: validation of a new classification according to venous drainage [e-pub ahead of print]. World Neurosurg. https://doi.org/10. 1016/j.wneu.2019.04.220, accessed May 7,2019.
5. Wolfe SQ, Cumberbatch NM, Aziz-Sultan MA, Tummala R, Morcos JJ. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery. 2010; 66(suppl 6):293-299.
4. Thomas AJ, Chua M, Fusco M, et al. Proposal of venous drainage-based classification system for carotid cavernous fistulae with validity assessment
Conflict of interest statement: The authors declare that the article content was composed in the absence of any
196
www.SCIENCEDIRECT.com
commercial or financial relationships that could be construed as a potential conflict of interest. Received 8 July 2019; accepted 7 August 2019 Citation: World Neurosurg. (2019) 131:196. https://doi.org/10.1016/j.wneu.2019.08.039 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.08.039