Treatment of CCFs with facial vein-superior ophthalmic vein approaches

Objective To evaluate the efficacy of facial vein-superior ophthalmic vein approach to embolize carotid-cavernous sinus fistulas.Metheds The involved cavernous sinus was catheterized through the femoral vein-facial vein- superior ophthalmic vein approach, GDC, EDC, free microcoil, or silk were used to pack the sinus and occlude the shunt. If therer was any difficulty in catheterizing the faical vein, facial vein was exposed surgically and punctured, and then, through the superior opthalmic vein, the cavernous sinus was packed. Results 16 cavernous sinuses in 14 CCF patients(5 traumatic CCFs, 9 dural CCFs) were catheterized through facial vein-superior ophthalmic vein approach, and the technical success was achieved in 15 cavernous sinuses. Immediate angiographic cure of the shunts was achieved in 11cases, residual shunts with inferior petral sinus drainage in 2. Facial vein occlusion was encountered in 1 patient during the facial vein catheterization, further packing of the cavernous sinus was not performed, but follow-up angiography at the 21 st day revealed the spontaneous cure of the shunt. The VI cranial nerve palsy present after balloon embolization in a type A CCF was not improved after the packing of the cavernous sinus. Ocular symptoms in other patients disappeared after tranvenous embolization. The clinical follow-up period ranged from 3 to 21 months, no recurrence of the symptoms was found. Follow-up angiography in 2 patients with residual shunting showed the unchanged shunts, no further embolization was performed. No follow-up angiography was performed in other patients.Conclusions The facial vein-superior ophthalmic vein approach can be chosen as an optimum treatment for dural CCFs, and an important alternative treatment for type A CCFs after the failure of the initial balloon embolization.