title: Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach.
  
  
  METHODS
  During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach.
  
  
  RESULTS
  All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms.
  
  
  CONCLUSIONS
  The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.
authors.affiliation: Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, P R China.
authors.forename: Bin
authors.initials: B
authors.lastname: Luo
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Chuan-Zhi
authors.initials: CZ
authors.lastname: Duan
authors.forename: Xu-Ying
authors.initials: XY
authors.lastname: He
authors.forename: Xi-Feng
authors.initials: XF
authors.lastname: Li
authors.forename: Tamrakar
authors.initials: T
authors.lastname: Karuna
authors.forename: Da-Qun
authors.initials: DQ
authors.lastname: Gu
authors.forename: Xiao-Ao
authors.initials: XA
authors.lastname: Long
authors.forename: Tie-Lin
authors.initials: TL
authors.lastname: Li
authors.forename: Shi-Zhong
authors.initials: SZ
authors.lastname: Zhang
authors.forename: Yi-Quan
authors.initials: YQ
authors.lastname: Ke
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000000981:diagnostic imaging; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods; D005123:Eye / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D019233:Retreatment; D012189:Retrospective Studies; D014680:Veins / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery; D055815:Young Adult