title: Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure.
abstract: OBJECTIVE
  To embolize carotid cavernous fistulas (CCFs) by means of transorbital puncture of the cavernous sinus (CS) and the cavernous segment of the internal carotid artery (ICA) through the superior orbital fissure.
  
  
  METHODS
  Five patients with CCF were treated with embolization of the CS, and six were treated with embolization of both the CS and the cavernous portion of the ICA after transorbital puncture. All except one had previously undergone occlusion of the ipsilateral proximal ICA before direct transorbital puncture.
  
  
  RESULTS
  The fistulas in these cases were all obliterated completely. Only two patients had temporary ptosis. No other remarkable complications were noted. The patent ICA on the side of the fistula in one patient remained patent after embolization.
  
  
  CONCLUSIONS
  Direct transorbital puncture through the superior orbital fissure is an alternate treatment for CCF, especially when the ipsilateral ICA has been occluded.
authors.affiliation: Department of Radiology, Veterans General Hospital, Taipei, Taiwan, Republic of China.
authors.forename: M M
authors.initials: MM
authors.lastname: Teng
authors.forename: J F
authors.initials: JF
authors.lastname: Lirng
authors.forename: T
authors.initials: T
authors.lastname: Chang
authors.forename: S S
authors.initials: SS
authors.lastname: Chen
authors.forename: W Y
authors.initials: WY
authors.lastname: Guo
authors.forename: C C
authors.initials: CC
authors.lastname: Cheng
authors.forename: W C
authors.initials: WC
authors.lastname: Shen
authors.forename: L S
authors.initials: LS
authors.lastname: Lee
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal; D002426:Cavernous Sinus; D002533:Cerebral Angiography; D006259:Craniocerebral Trauma / Q000150:complications; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods; D013100:Sphenoid Bone; D014057:Tomography, X-Ray Computed