Robotic-guided direct transtemporal embolization of an indirect carotid cavernous fistula

J Neurointerv Surg. 2023 Nov;15(11):1122-1123. doi: 10.1136/jnis-2022-019868. Epub 2023 Jan 10.


A middle-aged patient presented with right-sided chemosis, exophthalmos, and progressive visual loss. Digital subtraction angiography revealed a type D carotid-cavernous fistula (CCF). Transarterial embolization through the internal maxillary artery was unsuccessful, and there was no venous access to the CCF. A robotic-guided direct transtemporal embolization of the CCF with Onyx was performed, resulting in successful fistula obliteration and symptom resolution. This is the first reported case of a robotic-guided direct transcranial CCF embolization. We include a technical video that demonstrates this procedure (Supplemental File 1).

Keywords: Balloon; Fistula; Liquid Embolic Material; Technique; Vascular Malformation.