Superior ophthalmic vein approach for endovascular treatment of dural cavernous sinus fistulas

Objective To investigate the method for surgical exposure the superior ophthalmic vein with embolization of the cavernous sinus dural arteriovenous fistula and evaluate its efficacy and safety.Methods Surgical exposure of the superior ophthalmic vein was performed by eyelid incision and followed by catheterization and embolization with micro-coils for 16 patients with cavernous sinus dural arteriovenous fistulas.Results Clinical cure was achieved in all patients and complete angiographic obliteration of fistula was documented in 15 patients(94%).Residual fistula was left in 1 patients with compact occlusion via pterygoid drainage but disappeared one month later by manual compression of the carotid artery.Headache and vomitting were the most common symptoms after the embolization,other 2 patients had mild diplopia and relieved within two months.No permanent procedure-related morbidity and recurrence occurred during clinical follow up for 5 months to 6 years.Conclusion Surgical exposure of the superior ophthalmic vein for embolization of cavernous sinus dural arteriovenous fistula is a safe and efficient method.