title: Percutaneous trans-superior orbital fissure embolization of carotid-cavernous fistulas: technique and preliminary results.
abstract: OBJECTIVE
  To describe the technique of percutaneous, infraocular embolization of indirect carotid-cavernous fistulas (CCFs) and analyze the results in a small clinical series.
  
  
  METHODS
  A retrospective case series of 4 patients treated at Emory University Hospital.
  
  
  RESULTS
  Four patients with indirect CCFs and limited transvenous access were successfully treated with transcutaneous, infraocular embolization of the recipient cavernous sinus via the ipsilateral superior orbital fissure. Main outcome measures were clinical examination findings and cerebral angiography. All patients had either preservation or improvement in final visual outcome. One patient required early retreatment because of clot lysis and reopening of a secondary, iatrogenic direct CCF. Two patients suffered early postprocedural orbital hemorrhage requiring treatment with lateral canthotomy and inferior cantholysis.
  
  
  CONCLUSIONS
  Based these findings, percutaneous, infraocular, trans-superior orbital fissure embolization of CCFs is a viable alternative in patients with refractory fistulas failing management with more conventional techniques. Orbital hemorrhage is a significant risk, and availability of an ophthalmologist skilled in the management of this complication is imperative.
authors.affiliation: Departments of Radiology and daggerOphthalmology, Emory University Hospital, Atlanta, Georgia 30322, USA. sandra.narayanan@emoryhealthcare.org
authors.forename: Sandra
authors.initials: S
authors.lastname: Narayanan
authors.forename: Ann P
authors.initials: AP
authors.lastname: Murchison
authors.forename: Ted H
authors.initials: TH
authors.lastname: Wojno
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Dion
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit; D012189:Retrospective Studies