*Ege University Department of Ophthalmology, İzmir; †Uludag University Department of Ophthalmology, Bursa; ‡Baskent University Department of Ophthalmology, Ankara, Turkey.
Ophthalmic Plast Reconstr Surg. 2013 Jul-Aug;29(4):272-6. doi: 10.1097/IOP.0b013e3182916571.
To present the authors' experience treating dural carotid-cavernous sinus fistulas (CCF) with retrograde embolization via the thrombosed superior ophthalmic vein (SOV).
The medical records of 4 patients with dural CCFs treated via the thrombosed SOV were reviewed. All procedures were performed unilaterally in the interventional radiology unit with the administration of general anesthesia. The SOV was exposed via an eyelid crease incision, and then an angiocatheter was inserted in the vein and advanced through the segment with thrombosis to the cavernous sinus, where embolizing agents were deposited. After the procedure, the patients were followed up and evaluated clinically.
Three patients had unilateral CCFs, and 1 had a bilateral CCF (3 women and 1 man; age range, 58-68 years). The CCFs were Barrow type B (n=2) and Barrow type D (n=2). All patients had severe venous congestive orbital symptoms, chorioretinopathy, increased intraocular pressure, and visual loss. In all cases, the SOV appeared as a pale, thin, tortuous vessel adherent to the surrounding tissues during the surgical procedure. In 3 patients, the cavernous sinus was successfully embolized, and all symptoms were completely resolved without recurrence during follow up (3, 15, and 24 months). In the patient in whom the SOV could not be catheterized, the symptoms regressed slowly, but visual acuity remained unchanged during follow up (64 months).
Dural CCFs can be successfully treated through the SOV, even when the vein is thrombosed. Identification and catheterization of the thrombosed SOV may be difficult because of the tiny and fibrotic structure of the vein.
介绍作者通过逆行栓塞治疗血栓闭塞性眼上静脉（SOV）治疗硬脑膜颈动脉海绵窦瘘（CCF）的经验。
回顾了 4 例经血栓闭塞性 SOV 治疗的硬脑膜 CCF 患者的病历。所有手术均在介入放射科单元进行，采用全身麻醉。通过睑裂缝合切口暴露 SOV，然后将血管造影导管插入静脉并通过血栓段推进至海绵窦，在那里沉积栓塞剂。手术后，对患者进行随访和临床评估。
3 例患者为单侧 CCF，1 例为双侧 CCF（3 名女性和 1 名男性；年龄范围 58-68 岁）。CCF 为 Barrow 型 B（n=2）和 Barrow 型 D（n=2）。所有患者均有严重的静脉充血性眼眶症状、脉络膜视网膜病变、眼内压升高和视力丧失。在所有病例中，SOV 在手术过程中呈现出苍白、细、扭曲的血管，紧贴周围组织。在 3 例患者中，成功栓塞了海绵窦，所有症状在随访期间完全缓解且无复发（3、15 和 24 个月）。在 SOV 无法导管化的患者中，症状缓慢消退，但在随访期间视力保持不变（64 个月）。
即使静脉血栓形成，硬脑膜 CCF 也可以通过 SOV 成功治疗。由于静脉细小且纤维化，识别和导管化血栓闭塞性 SOV 可能具有挑战性。
