title: Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature.
abstract: Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe a case example with bilateral Barrow Type B CCFs, which were inaccessible using the traditional transvenous approach. Hence, a direct transorbital approach, performed under fluoroscopic guidance, was employed to successfully obliterate the CCF. At five months follow-up, the patient was recovering without complications. This case delineates the technical aspects of transorbital CCF embolization and demonstrates that this approach is a viable alternative to conventional transvenous methods for appropriately selected CCF cases. We supplement our case example and technical note with a literature review of this approach.
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Mastorakos
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: James P
authors.initials: JP
authors.lastname: Caruso
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Schmitt
authors.affiliation: Department of Neurological Surgery, University Of Virginia.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Buell
authors.affiliation: Department of Neurological Sugery, University Of Virginia.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Raper
authors.affiliation: Department of Interventional Neuroradiology, University Of Virginia.
authors.forename: Avery
authors.initials: A
authors.lastname: Evans
authors.affiliation: Department of Ophthalmology, University Of Virginia.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Newman
authors.affiliation: Department of Interventional Neuroradiology, University Of Virginia.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Jensen
keywords: carotid cavernous fistula; ccf; dural arteriovenous fistula; endovascular; fistula; transorbital