First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula: illustrative case

Justin M. Cappuzzo, Ammad A. Baig, William Metcalf-Doetsch, Muhammad Waqas, Andre Monteiro, Elad I. Levy*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Failure to reach the cavernous sinus after multiple transvenous attempts, although rare, can be challenging for neurointerventionists. The authors sought to demonstrate technical considerations and nuances of the independent performance of a novel hybrid surgical and endovascular transpalpebral approach through the superior ophthalmic vein (SOV) for direct coil embolization of an indirect carotid cavernous fistula (CCF), and they review salient literature regarding the transpalpebral approach. OBSERVATIONS An illustrative case, including patient history and presentation, was reviewed. PubMed, MEDLINE, and Embase databases were searched for articles published between January 1, 2000, and September 30, 2021, that reported $1 patient with a CCF treated endovascularly via the SOV approach. Data extracted included sample size, treatment modality, surgical technique, performing surgeon specialty, and procedure outcome. The authors’ case illustration demonstrates the technique for the hybrid transpalpebral approach. For the review, 273 unique articles were identified; 14 containing 74 treated patients fulfilled the inclusion criteria. Oculoplastic surgery was the most commonly involved specialty (5 of 14 studies), followed by ophthalmology (3 of 14). Coiling alone was the treatment of choice in 12 studies, with adjunctive use of Onyx (Medtronic) in 2. LESSONS The authors’ technical case description, video, illustrations, and review provide endovascular neurosurgeons with a systematic guide to conduct the procedure independently.

Original languageEnglish (US)
Article numberCASE22115
JournalJournal of Neurosurgery: Case Lessons
Volume3
Issue number25
DOIs
StatePublished - Jun 2022

Keywords

  • coil
  • endovascular embolization
  • indirect carotid cavernous fistula
  • superior ophthalmic vein
  • transpalpebral

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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