+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Direct surgery of carotid cavernous fistulae and dural arteriovenous malformations of the cavernous sinus



Direct surgery of carotid cavernous fistulae and dural arteriovenous malformations of the cavernous sinus



Neurosurgery 41(4): 798-805; Discussion 805-6



OBJECTIVE: To save the patency of the internal carotid artery (ICA) during the treatment of carotid cavernous fistulae or cavernous sinus dural arteriovenous malformations, direct surgery of the cavernous sinus after failure of endovascular treatment was attempted in this study. METHODS: A total of 78 patients with carotid cavernous fistulae or cavernous sinus dural arteriovenous malformations were treated. Obliteration of the fistulous rent and preservation of the ICA were the therapeutic goals. All patients, except one in whom acute bleeding occurred, received endovascular treatment as the first treatment. In 18 (23.4%) of these 77 patients, it was not possible to obliterate the fistulous rents without sacrificing the ICAs. The 18 patients and the 1 patient with acute bleeding underwent direct surgery to open the cavernous sinus. RESULTS: Various methods, including suturing or clipping the fistulae, sealing the fistulae with fascia and acrylate glue, and packing the cavernous sinus were applied. In each of three complicated cases, the cavernous segment of the ICA was trapped and an intracranial bypass from the petrous segment to the supraclinoid segment was performed. There was no mortality, and the most common morbidity was transient oculomotor palsy, which occurred in eight patients. Follow-up angiography revealed that the ICAs or bypass grafts were thrombosed in 5 of the 19 patients who had undergone surgery. CONCLUSION: In this series, the overall ICA patency rate of patients who underwent embolization and surgery was 94%, and the obliteration rate of the fistulae was 100%. Direct surgery of the cavernous sinus as a complimentary treatment of embolization can increase the preservation rate of the ICA.

(PDF emailed within 0-6 h: $19.90)

Accession: 008481917

Download citation: RISBibTeXText

PMID: 9316040

DOI: 10.1097/00006123-199710000-00006


Related references

Transorbital direct puncture of the posterior cavernous sinus through the internal carotid artery for embolization of isolated cavernous sinus dural arteriovenous fistula. Journal of Neurointerventional Surgery 5(2): E1, 2013

Carotid-cavernous sinus fistulae and dural arteriovenous shunts. Vascular Surgery 8(1): 60-69, 1974

Cavernous sinus fistulas: carotid cavernous fistulas and dural arteriovenous malformations. Current Neurology and Neuroscience Reports 3(5): 415-420, 2003

Shifting of dural arteriovenous malformation from the cavernous sinus to the sigmoid sinus to the transverse sinus after transvenous embolization. A case of left spontaneous carotid-cavernous sinus fistula. Surgical Neurology 37(1): 30-38, 1992

True anatomical compartmentalization of the cavernous sinus in a patient with bilateral cavernous dural arteriovenous fistulae. Case report. Journal of Neurosurgery 79(4): 592-595, 1993

Posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula treated by a direct access cavernous sinus approach. Journal of Neurointerventional Surgery 6(10): E49, 2015

Posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula treated by a direct access cavernous sinus approach. BMJ Case Reports 2013, 2014

Transvenous injection of n-Butyl cyanoacrylate combined with placement of coils in cavernous sinus for treatment of cavernous dural arteriovenous fistulae. Journal of Medical Colleges of Pla 25(5): 285-292, 2010

Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression. Neurosurgery 60(2): 253-7; Discussion 257-8, 2007

Three cases of spontaneous bilateral external carotid-cavernous sinus fistula (dural arteriovenous shunts in the region of the cavernous sinus). No Shinkei Geka. Neurological Surgery 3(7): 607-613, 1975

External Manual Carotid Compression is Effective in Patients with Cavernous Sinus Dural Arteriovenous Fistulae. Interventional Neuroradiology 13 Suppl 1: 115-122, 2007

Combined pretemporal and endovascular approach to the cavernous sinus for the treatment of carotid-cavernous dural fistulae: technical case report. Neurosurgery 44(2): 415-418, 1999

External Carotid Artery Embolization of Dural Arteriovenous Malformations Involving the Cavernous Sinus. Acta Radiologica 31(2): 197-201, 1990

Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure: Asystole Resulting from the Trigeminocardiac Reflex. A Case Report. Interventional Neuroradiology 15(2): 179-184, 2010

A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula: case report. Journal of Neurosurgery 108(3): 588-590, 2008