Department of Radiology, Huntington Memorial Hospital, Pasadena, California, USA.
Center for Oculofacial and Orbital Surgery, Los Angeles, California, USA.
J Neurointerv Surg. 2018 Jun;10(6):e11. doi: 10.1136/neurintsurg-2017-013229.rep. Epub 2018 Apr 7.
Endovascular treatment of carotid cavernous fistulas (CCFs) via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. A 61-year-old woman presented with a symptomatic CCF with all but one of the venous access routes to the CCF thrombosed, leaving an engorged superficial middle cerebral vein (SMCV) as the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. The CCF was completely occluded by coiling and Onyx embolization. The patient made an uneventful recovery, with resolution of her symptoms. To the best of our knowledge, this access route has not been previously reported in the treatment of CCFs.
经静脉途径的血管内治疗是颈动脉海绵窦瘘（CCFs）的标准治疗方法，但在罕见情况下，由于通常使用的静脉途径缺失或血栓形成，这种方法具有挑战性。一位 61 岁女性因有症状的 CCF 就诊，除了一条通往 CCF 的静脉外，所有静脉均已血栓形成，仅留下一条扩张的大脑浅中静脉（SMCV）作为海绵窦唯一的静脉流出道。在仔细导航乙状窦、Labbe 静脉和 SMCV 后，可进入 CCF，从而无需手术进入 SMCV 或直接经眶穿刺。通过线圈和 Onyx 栓塞完全闭塞了 CCF。患者恢复顺利，症状缓解。据我们所知，这种入路以前尚未用于治疗 CCFs。
