title: Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite.
abstract: Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite. This 82-year-old man presented with severe chemosis and proptosis of the right eye. Digital subtraction angiography revealed a Type B CCF with a feeding artery arising from the meningohypophyseal trunk of the right cavernous segment of the internal carotid artery. The CCF drained through a thrombosed right superior ophthalmic vein that ended deep in the orbit; there were no patent sinuses or venous plexuses connecting to the CCF. An endoscope-assisted transsphenoidal puncture created direct access to the nidus for embolization. Embolic agents were deployed through the puncture needle to achieve complete obliteration. Endoscope-assisted transsphenoidal puncture of the cavernous sinus is a feasible alternative to treat difficult-to-access CCFs in a neurosurgical hybrid operating suite.
authors: Departments of 1 Neurosurgery and.
authors: Chien-Lun
authors: CL
authors: Tang
authors: Departments of 1 Neurosurgery and.
authors: Chih-Hsiang
authors: CH
authors: Liao
authors: Radiology, Neurological Institute, Taichung Veterans General Hospital; and.
authors: Wen-Hsien
authors: WH
authors: Chen
authors: Departments of 1 Neurosurgery and.|Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China.
authors: Shih-Chieh
authors: SC
authors: Shen
authors: Departments of 1 Neurosurgery and.
authors: Chung-Hsin
authors: CH
authors: Lee
authors: Departments of 1 Neurosurgery and.|Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China.
authors: Hsu-Tung
authors: HT
authors: Lee
authors: Departments of 1 Neurosurgery and.|Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China.
authors: Yuang-Seng
authors: YS
authors: Tsuei
mesh_terms: D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D002426:Cavernous Sinus / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D044582:Neuroendoscopes; D019635:Neurosurgical Procedures; D009873:Operating Rooms; D011677:Punctures / Q000295:instrumentation / Q000379:methods*; D013100:Sphenoid Bone
keywords: CCF = carotid-cavernous fistula; CS = cavernous sinus; DSA = digital subtraction angiography; ECA = external carotid artery; GDC = Guglielmi Detachable Coil; ICA = internal carotid artery; NBCA = N-butyl 2-cyanoacrylate; SOV = superior ophthalmic vein; carotid-cavernous fistula; coil; embolization; endonasal; endoscope; endovascular; hybrid surgery; interventional neurosurgery; transsphenoidal approach