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首页> 外文期刊>Neurosurgery >Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access.
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Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access.

机译：通过上眼眼静脉的手术入路用于颈内海绵状瘘的血管内治疗，而传统的血管内入路失败。

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BACKGROUND: Endovascular embolization is the preferred treatment for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of tortuosity, hypoplasia, or stenosis of the normal venous routes. In these cases, direct operative cannulation of the arterialized superior ophthalmic vein (SOV) offers an excellent alternative approach. METHODS: We reviewed the records of patients who underwent surgical cannulation of the SOV in preparation for embolization and identified 10 patients with indirect CCF, all of whom presented with ocular signs and symptoms. All had previously undergone unsuccessful endovenous attempts at treatment at our institution. In the operating room, the SOV was catheterized under microscopic magnification through an eyelid or eyebrow incision, and the patients were taken directly to the angiographic suite for embolization. RESULTS: In 9 of 10 patients, embolization of the CCF was complete with clinical improvement. In 1 case, navigation of the catheter into the SOV proved difficult, and the procedure was aborted because of contrast extravasation after partial embolization. One patient required a small orbital osteotomy to localize the SOV. There were no clinical complications and no known recurrences. Cosmetic results were excellent in all patients. CONCLUSION: Surgical access to the superior ophthalmic vein for embolization of a CCF is an excellent and definitive alternative treatment when traditional endovenous routes are inaccessible. The operative approach to the SOV is straightforward and can be performed safely and expeditiously by the neurovascular team.
机译：背景：血管内栓塞术是颈动脉海绵窦瘘（CCF）的首选治疗方法，但由于正常静脉曲折，发育不全或狭窄，可能无法插入海绵窦。在这些情况下，直接手术方式插入动脉化眼上静脉（SOV）提供了一种极好的替代方法。方法：我们回顾了接受SOV手术插管以准备栓塞的患者的记录，并鉴定了10例间接CCF患者，所有患者均出现眼部症状和体征。所有人都曾在我们机构接受过不成功的静脉尝试治疗。在手术室中，将SOV在显微镜放大下通过眼睑或眉毛切口插入导管，并将患者直接带入血管造影套件进行栓塞。结果：10例患者中的9例，CCF的栓塞已完成，临床效果得到改善。在1例病例中，证明导管很难进入SOV，并且由于部分栓塞后出现造影剂外渗而中止了手术。一名患者需要进行小眶截骨术才能定位SOV。没有临床并发症，也没有已知的复发。所有患者的美容效果均极佳。结论：当传统的静脉途径无法接近时，通过外科手术途径进入眼上静脉进行CCF栓塞是一种极好的且确定的替代疗法。 SOV的手术方法简单明了，可以由神经血管小组安全，迅速地执行。

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