Lyons Lance J, Smith Sarah A, Diaz Orlando, Diaz Humberto, Vickers Aroucha, Prospero Claudia, Lee Andrew G
Department of Ophthalmology & Visual Sciences, University of Texas Medical BranchGalvestonTexas.
School of Medicine, University of Texas Medical BranchGalvestonTexas.
Proc (Bayl Univ Med Cent). 2019 May 24;32(3):382-384. doi: 10.1080/08998280.2019.1596502. eCollection 2019 Jul.
This case report highlights utilization of image-guided, percutaneous transorbital direct cavernous sinus puncture to embolize an anteriorly draining carotid cavernous fistula (CCF) when conventional transarterial and transvenous approaches were not feasible. An 86-year-old man with a known posterior draining CCF developed acute unilateral proptosis, pain, and vision loss ("red-eyed shunt"). Cerebral angiogram revealed the dural CCF to be draining anteriorly into partially thrombosed ophthalmic veins. After failed transarterial and transvenous attempts, a percutaneous transorbital approach was used to successfully embolize the fistula using the Onyx Liquid Embolic System according to the visual needle path generated by the Seimens Syngo iGuide. To our knowledge, this is the first reported case of percutaneous transorbital direct embolization of a CCF utilizing the Seimens Syngo iGuide.
本病例报告强调了在传统经动脉和经静脉方法不可行时，利用图像引导的经皮经眶直接海绵窦穿刺来栓塞向前引流的颈内动脉海绵窦瘘（CCF）。一名已知存在向后引流CCF的86岁男性出现急性单侧眼球突出、疼痛和视力丧失（“红眼分流”）。脑血管造影显示硬脑膜CCF向前引流至部分血栓形成的眼静脉。经动脉和经静脉尝试失败后，采用经皮经眶入路，根据西门子Syngo iGuide生成的可视针道，使用Onyx液体栓塞系统成功栓塞瘘管。据我们所知，这是首例利用西门子Syngo iGuide经皮经眶直接栓塞CCF的报道病例。
