title: Treatment of Dural Carotid-Cavernous Fistulas via the Medial Ophthalmic Vein.
abstract: OBJECTIVE
  To present a novel approach to treatment of dural carotid-cavernous fistulas via the medial ophthalmic vein.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  In this retrospective case series, we present 2 patients (3 eyes) with Type C dural CCFs, who had failed cannulation via the conventional transfemoral route and the transorbital superior ophthalmic vein approach. They subsequently underwent CCF occlusion via an anterior orbital approach through the medial ophthalmic veins, at the Department of Ophthalmology, National University Hospital Singapore. CCF occlusion was confirmed intraoperatively using angiography. Both patients were evaluated postoperatively for best-corrected visual acuity and resolution of clinical signs and symptoms.
  
  
  RESULTS
  Successful occlusion of CCFs via the medial ophthalmic veins were achieved in all three orbits, with excellent visual and cosmetic outcomes postoperatively.
  
  
  CONCLUSIONS
  Dural CCFs may potentially lead to severe visual dysfunction and should be diagnosed and treated promptly. When all venous routes have been exhausted, the transorbital approach via the medial ophthalmic vein remains an excellent and viable alternative to access the fistula. Close cooperation between the orbital, anesthetic and radiological teams is essential in ensuring success of the operation.
authors.affiliation: a Department of Ophthalmology , National University Health System , Singapore and.
authors.forename: Nigel C S
authors.initials: NC
authors.lastname: Lim
authors.affiliation: a Department of Ophthalmology , National University Health System , Singapore and.
authors.forename: Hazel Anne H E
authors.initials: HA
authors.lastname: Lin
authors.affiliation: b Parkway Radiology, Mount Elizabeth Hospital , Singapore.
authors.forename: Cheng Kang
authors.initials: CK
authors.lastname: Ong
authors.affiliation: a Department of Ophthalmology , National University Health System , Singapore and.
authors.forename: Gangadhara
authors.initials: G
authors.lastname: Sundar
mesh_terms: D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000379:methods; D002426:Cavernous Sinus / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014680:Veins
keywords: Carotid-cavernous sinus fistula; carotid sinus coiling; hybrid operating theatre; medial ophthalmic vein