Abstract ID: 26-489
Direct Superior Ophthalmic Vein Venopuncture Approach for Embolization of Carotid-Cavernous Fistulas: A Case Series
Author: Amee Azad Base Hospital / Institution: Mass Eye and Ear/Harvard University
Presentation Type: ePoster Presentation
Purpose
To report outcomes of cavernous sinus embolization via direct superior ophthalmic vein (SOV) venopuncture for carotid-cavernous fistulas (CCF) at a single institution.
Methods
Retrospective chart review of patients with CCFs treated via direct SOV venopuncture. Preoperative assessment included visual acuity (VA), intraocular pressure (IOP), relative afferent pupillary defect (rAPD), color vision, and Hertel exophthalmometry.
Results
Four patients (2 female, 2 male; mean age 68, range 49–81) with CCF treated via a direct SOV venopuncture approach. Barrow fistula types included B (n=1), C (n=1), and D (n=2). One patient had a history of head trauma and the other 3 had a history of chronic hypertension. Mean symptom duration prior to intervention was 7.5 months (range 2–18). Mean preoperative IOP was 25.0 mmHg; an rAPD was present in 2 patients (50%); mean proptosis of the affected eye was 5.5mm relative to the fellow eye. Color plate testing was reduced preoperatively where recorded in 3 out of 4 patients. Direct SOV venopuncture was technically successful in 3 of 4 patients (75%). In the 3 successful cases, VA improved or was maintained, IOP normalized, and proptosis decreased by a mean of 4.8mm. The rAPD resolved in 1 of 2 affected patients; the other showed color plate improvement (0 to 7 plates) despite persistent RAPD. The failed case was able to be successfully embolized under fluoroscopic guidance with preservation of full afferent function pre- and post-operatively with improvement and 0.5mm improvement in Hertel exophthalmometry. Total follow-up ranged from 3 days to 43 months.
Conclusion
The SOV direct venopuncture approach for CCF was successful in 3 out of 4 patients with meaningful visual and functional recovery. Preoperative angiographic assessment of distal SOV patency and size is essential for surgical planning.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Meghana | Konda | Mass Eye and Ear/Harvard University |
| Lisa | Lin | Wilmer Eye Institute/Johns Hopkins University |
| Michael | Yoon | Mass Eye and Ear/Harvard University |