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The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx.

Publication ,  Journal Article
Chalouhi, N; Dumont, AS; Tjoumakaris, S; Gonzalez, LF; Bilyk, JR; Randazzo, C; Hasan, D; Dalyai, RT; Rosenwasser, R; Jabbour, P
Published in: Neurosurg Focus
May 2012

OBJECT: Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. METHODS: The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients. RESULTS: A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations. CONCLUSIONS: Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.

Duke Scholars

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

May 2012

Volume

32

Issue

5

Start / End Page

E13

Location

United States

Related Subject Headings

  • Vena Cava, Superior
  • Treatment Outcome
  • Retrospective Studies
  • Polyvinyls
  • Orbit
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chalouhi, N., Dumont, A. S., Tjoumakaris, S., Gonzalez, L. F., Bilyk, J. R., Randazzo, C., … Jabbour, P. (2012). The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx. Neurosurg Focus, 32(5), E13. https://doi.org/10.3171/2012.1.FOCUS123
Chalouhi, Nohra, Aaron S. Dumont, Stavropoula Tjoumakaris, L Fernando Gonzalez, Jurij R. Bilyk, Ciro Randazzo, David Hasan, Richard T. Dalyai, Robert Rosenwasser, and Pascal Jabbour. “The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx.Neurosurg Focus 32, no. 5 (May 2012): E13. https://doi.org/10.3171/2012.1.FOCUS123.
Chalouhi N, Dumont AS, Tjoumakaris S, Gonzalez LF, Bilyk JR, Randazzo C, et al. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx. Neurosurg Focus. 2012 May;32(5):E13.
Chalouhi, Nohra, et al. “The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx.Neurosurg Focus, vol. 32, no. 5, May 2012, p. E13. Pubmed, doi:10.3171/2012.1.FOCUS123.
Chalouhi N, Dumont AS, Tjoumakaris S, Gonzalez LF, Bilyk JR, Randazzo C, Hasan D, Dalyai RT, Rosenwasser R, Jabbour P. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx. Neurosurg Focus. 2012 May;32(5):E13.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

May 2012

Volume

32

Issue

5

Start / End Page

E13

Location

United States

Related Subject Headings

  • Vena Cava, Superior
  • Treatment Outcome
  • Retrospective Studies
  • Polyvinyls
  • Orbit
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies