Treatment of carotid-cavernous sinus fistulas using a detachable balloon catheter through the superior ophthalmic vein
A. M. Hanneken, N. R. Miller, G. M. Debrun and H. J. Nauta
Wilmer Ophthalmological Institute, Johns Hopkins Medical Institutions, Baltimore.
Four consecutive patients with carotid-cavernous sinus fistulas that could
not be treated by the standard techniques of endoarterial balloon occlusion
or embolization were successfully treated by advancement of a detachable
balloon catheter through the ipsilateral superior ophthalmic vein. Under
angiographic monitoring, the balloon was passed into the cavernous sinus,
inflated to close the fistula, and detached. Three of the patients had a
spontaneous fistula, and one had a traumatic fistula that had previously
been trapped unsuccessfully. All patients had complete resolution of
symptoms and signs after occlusion of the fistula. There were no
intraoperative or postoperative complications. The transvenous approach to
the cavernous sinus through the superior ophthalmic vein is a safe,
effective treatment of carotid-cavernous sinus fistulas, whether they are
direct or dural in nature.
