SURGICAL VIDEO Coiling of a Carotidocavernous Fistula via the Foramen Ovale: 2-Dimensional Operative Video ∗ ‡ ‡ Waleed Brinjikji, MD , Thomas Sorenson, BS ,JohnAtkinson,MD , ∗ ∗ ‡ Harry Cloft, MD, PhD , Giuseppe Lanzino, MD ∗ ‡ Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota Carotidocavernous fistulae (CCFs) are uncommon vascular lesions that often result in progressive ocular complications or Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ intracranial hemorrhage if not treated. Different access routes opx224 can be used to treat indirect fistulae of the cavernous sinus. In this video, we illustrate the access obtained through a percuta- neous transforamen ovale direct puncture. We present a case of a Disclosure 51-yr-old female presenting with diplopia and pulsatile tinnitus. The authors have no personal, financial, or institutional interest in any of the She was diagnosed with a Barrow Type D CCF with cerebellar drugs, materials, or devices described in this article. cortical venous drainage. After conventional transvenous routes for treatment of this lesion were unsuccessful, as well as a percu- REFERENCE taneous transorbital direct puncture, we successfully accessed the lesion through a percutaneous transforamen ovale direct 1. Gil A,López-Ibor L,Lopez-Flores G,Cuellar H,Murias E,Rodríguez-Boto G. Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture. The cavernous sinus was densely packed with coils from puncture. J Neurosurgery. 2013;119(1):247-251. the origin of the superior ophthalmic vein to the superior petrosal sinus. Final control cerebral angiograms demonstrated complete COMMENT occlusion of the fistula. The patient had a resolution of tinnitus and improvement in vision at last follow-up. A transforamen he authors describe a novel approach to the cavernous sinus for ovale puncture is a safe and viable route for treating CCFs the treatment of a CCF through a foramen ovale approach. These that are unsuccessfully reached by conventional transarterial lesions can be technically challenging and using the correct approach to and transvenous embolization techniques. Informed consent was ensure complete obliteration is paramount to achieve cure. This approach obtained for the procedure illustrated. However, neither IRB should be a “salvage,” as most times access is direct when a thorough and approval nor patient consent is required per institutional policy detailed 6-vessel angiogram is performed. for retrospective, single-cases in which no identifiable patient Erol Veznedaroglu information is shared. Pennington, New Jersey OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 6 | JUNE 2018 | 709 Downloaded from https://academic.oup.com/ons/article-abstract/14/6/709/4587633 by Ed 'DeepDyve' Gillespie user on 17 June 2018
Operative Neurosurgery – Oxford University Press
Published: Nov 2, 2017
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