title: Coiling of a carotid cavernous sinus fistula via microsurgical venotomy: recommendation of a combined neurosurgical and endovascular approach.
abstract: BACKGROUND
  Endovascular treatment of a carotid cavernous fistula (CCF) via a transvenous approach is standard but, in rare cases, the standard approach is not feasible due to vessel occlusion or anomalies. In such cases it remains a challenge to find an alternative route for complete treatment.
  
  
  METHODS
  A 42-year-old patient presented with a symptomatic CCF (Barrow type C). An endovascular approach to the CCF was not possible due to abnormal venous vessel architecture, so a combined surgical and interventional approach was undertaken. A custom-tailored craniotomy was first performed to access the major sylvian vein. After venotomy and insertion of a microcatheter, the CCF was completely occluded by coiling and embolization conventionally. The symptoms regressed and had almost completely disappeared at follow-up.
  
  
  CONCLUSIONS
  An individually tailored strategy with a combined surgical and endovascular approach enabled full treatment with minimal risk for the patient.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. hi-jae.heiroth@uni-duesseldorf.de
authors.forename: Hi-Jae
authors.initials: HJ
authors.lastname: Heiroth
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.forename: Nima
authors.initials: N
authors.lastname: Etminan
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
mesh_terms: D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000601:surgery*; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography