title: Carotid cavernous fistula: embolization via a bilateral superior ophthalmic vein approach.
abstract: We report the case of a 74-year-old woman with a complex indirect (Barrow D) carotid cavernous sinus fistula. The patient was treated incrementally and finally cured by a rarely reported bilateral retrograde direct transvenous approach via the superior ophthalmic vein. The treatment of the complex carotid cavernous fistula with multiple bilateral fistula points showed additional complexity due to a partially thrombosed left superior ophthalmic vein, which required a combined microsurgical and endovascular treatment, showing that treatment can be achieved, if necessary, by catheterization of a thrombosed orbital vein.
authors.affiliation: Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Berlis
authors.forename: Joachim
authors.initials: J
authors.lastname: Klisch
authors.forename: Uwe
authors.initials: U
authors.lastname: Spetzger
authors.forename: Michael
authors.initials: M
authors.lastname: Faist
authors.forename: Martin
authors.initials: M
authors.lastname: Schumacher
mesh_terms: D000368:Aged; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications / Q000628:therapy*; D004621:Embolization, Therapeutic; D005123:Eye / Q000098:blood supply*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010690:Phlebography; D013479:Superior Vena Cava Syndrome / Q000150:complications / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures; D014680:Veins / Q000601:surgery