Unit of Maxillofacial Surgery, IRCCS San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
Casa Di Cura San Paolo, Via del Quadrifoglio, 3, 51100, Pistoia, Italy.
Oral Maxillofac Surg. 2022 Mar;26(1):45-51. doi: 10.1007/s10006-021-00961-z. Epub 2021 Apr 5.
Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus (CS) and carotid arteries. In direct CCFs, a transarterial route is often the preferred vascular access; in case of indirect CCFs, the complex anatomy of the feeder vessels and their extra-intracranial anastomosis makes the transarterial embolization challenging and often ineffective. The aim of this study was to review our experience with the transorbital approach to treat patients affected by CCF who have already experienced an endovascular failure procedure, in order to assess this salvage technique feasibility, by analyzing possible risks and complications.
We performed a retrospective study of all patients affected by CCFs who underwent transorbital embolization between February 2017 and February 2019 at our institution.
All patients (3 cases) tolerated both the retrograde embolization and the direct surgical approach with clinical improvement; the closure of the fistula was complete and verified intraoperatively by angiography. Esthetic result was acceptable in all cases with reduction of the proptosis and the intraocular pressure, and increased visual acuity. There were no complications or clinical recurrence.
Transorbital approach for the endovascular treatment of CCFs is a feasible and safe salvage procedure, which can find indication after other endovascular access failures.
海绵窦动静脉瘘（CCFs）是海绵窦（CS）和颈动脉之间异常连接。在直接 CCFs 中，经动脉途径通常是首选的血管入路；在间接 CCFs 中，供血血管及其颅内外吻合的复杂解剖结构使得经动脉栓塞具有挑战性，且通常无效。本研究旨在回顾我们采用经眶入路治疗已行血管内治疗失败的 CCF 患者的经验，以评估该挽救性技术的可行性，分析可能的风险和并发症。
我们对 2017 年 2 月至 2019 年 2 月期间在我院接受经眶栓塞治疗的所有 CCFs 患者进行了回顾性研究。
所有患者（3 例）均能耐受逆行栓塞和直接手术入路，且临床症状均得到改善；瘘口完全闭合，并在术中通过血管造影得到证实。所有病例的美容效果均可接受，眼球突出度、眼压降低，视力提高。无并发症或临床复发。
经眶入路治疗 CCFs 的血管内治疗是一种可行且安全的挽救性手术，可在其他血管内入路失败后应用。
