Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.
A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.
Michels
Kevin S
KS
Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA. michelke@ohsu.edu
Ng
John D
JD
Falardeau
Julie
J
Roberts
Warren G
WG
Petersen
Bryan
B
Nesbit
Gary M
GM
Barnwell
Stanley L
SL
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D004172:Diplopia / Q000209:etiology; D004621:Embolization, Therapeutic / Q000379:methods*; D005094:Exophthalmos / Q000209:etiology; D005123:Eye / Q000098:blood supply*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology; D010690:Phlebography; D014680:Veins