The Superior Ophthalmic Vein Approach for the Treatment of Carotid-Cavernous Fistulas: Our First Experience

Carotid cavernous fistulas (CCF) constitute between 10-15% of all intracranial vascular malformations. Clinical symptoms of indirect CCFs include chemosis, conjunctival injection, proptosis, diminished visual acuity, ophthalmoplegia, retro-orbital bruit, periorbital swelling, and hyperlacrimation, in the setting of associated cortical venous reflux, intracranial hemorrhage. Treatment of choice for symptomatic carotid cavernous and cavernous dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization.