Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure

Radiology. 1995 Mar;194(3):705-11. doi: 10.1148/radiology.194.3.7862966.


Purpose: To embolize carotid cavernous fistulas (CCFs) by means of transorbital puncture of the cavernous sinus (CS) and the cavernous segment of the internal carotid artery (ICA) through the superior orbital fissure.

Materials and methods: Five patients with CCF were treated with embolization of the CS, and six were treated with embolization of both the CS and the cavernous portion of the ICA after transorbital puncture. All except one had previously undergone occlusion of the ipsilateral proximal ICA before direct transorbital puncture.

Results: The fistulas in these cases were all obliterated completely. Only two patients had temporary ptosis. No other remarkable complications were noted. The patent ICA on the side of the fistula in one patient remained patent after embolization.

Conclusion: Direct transorbital puncture through the superior orbital fissure is an alternate treatment for CCF, especially when the ipsilateral ICA has been occluded.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / etiology
  • Arteriovenous Fistula / therapy*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / etiology
  • Carotid Artery Diseases / therapy*
  • Carotid Artery, Internal
  • Cavernous Sinus*
  • Cerebral Angiography
  • Craniocerebral Trauma / complications
  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Punctures / methods
  • Sphenoid Bone
  • Tomography, X-Ray Computed