TY - JOUR
T1 - First reported single-surgeon transpalpebral hybrid approach for indirect cavernous carotid fistula
T2 - illustrative case
AU - Cappuzzo, Justin M.
AU - Baig, Ammad A.
AU - Metcalf-Doetsch, William
AU - Waqas, Muhammad
AU - Monteiro, Andre
AU - Levy, Elad I.
N1 - Publisher Copyright:
© 2022 The authors.
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - coil
KW - endovascular embolization
KW - indirect carotid cavernous fistula
KW - superior ophthalmic vein
KW - transpalpebral
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U2 - 10.3171/CASE22115
DO - 10.3171/CASE22115
M3 - Article
C2 - 35733840
AN - SCOPUS:85160563766
SN - 2694-1902
VL - 3
JO - Journal of Neurosurgery: Case Lessons
JF - Journal of Neurosurgery: Case Lessons
IS - 25
M1 - CASE22115
ER -