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Abstract：
Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. In rare circumstances patients\' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation.
We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. The first is a 35-year-old man with symptomatic, traumatic, right-sided CCF, treated with endovascular therapy (transarterial detachable balloon placement). The other cases were treated with contrasting surgical and endovascular combined approaches because of unique vascular challenges. The second is a 71-year-old woman with spontaneous right-sided CCF whose carotid sinus was accessed and embolized through a transpalpebral cutdown of the SOV. The third case is a 70-year-old man with symptomatic, spontaneous bilateral CCF. After unsuccessful transarterial and transvenous endovascular approaches, transorbital (intracranial) SOV cutdown and cannulation were performed to embolize the shunting fistula.
Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.
We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. The first is a 35-year-old man with symptomatic, traumatic, right-sided CCF, treated with endovascular therapy (transarterial detachable balloon placement). The other cases were treated with contrasting surgical and endovascular combined approaches because of unique vascular challenges. The second is a 71-year-old woman with spontaneous right-sided CCF whose carotid sinus was accessed and embolized through a transpalpebral cutdown of the SOV. The third case is a 70-year-old man with symptomatic, spontaneous bilateral CCF. After unsuccessful transarterial and transvenous endovascular approaches, transorbital (intracranial) SOV cutdown and cannulation were performed to embolize the shunting fistula.
Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.
摘要：
颈动脉海绵窦瘘（CCF）是海绵窦内动脉和静脉循环之间的异常通信，表现在无数的神经和眼科后遗症。在极少数情况下，患者独特的血管解剖结构排除了这种病理的标准血管内治疗。保证联合手术和血管内方法，其中海绵窦通过眼上静脉（SOV）暴露进入，削减，和插管。
我们描述了2017年至2019年间在我们的四元神经血管转诊中心治疗的3例CCF病例。第一个是有症状的35岁男子,创伤性,右侧CCF,血管内治疗（经动脉可拆卸球囊放置）。由于独特的血管挑战，其他病例采用手术和血管内联合方法进行治疗。第二个是一名71岁的女性，患有自发性右侧CCF，其颈动脉窦通过SOV的椎管切开而被进入并栓塞。第三例是一名有症状的七十岁男子,自发性双侧CCF。经动脉和经静脉血管内途径不成功后，进行了经眶（颅内）SOV切除和插管以栓塞分流瘘。
血管内方法被充分描述为CCF的主要治疗方法，但并非对所有患者都是可能的。在个别血管解剖结构不适合经动脉或静脉介入或栓塞的情况下，手术和血管内联合入路可能是合适的。我们描述了3个案例，说明了CCF的干预范围，以及2名复杂患者的治疗技术方面，直接CCF，使用依赖于SOV切开和插管的栓塞方法。
我们描述了2017年至2019年间在我们的四元神经血管转诊中心治疗的3例CCF病例。第一个是有症状的35岁男子,创伤性,右侧CCF,血管内治疗（经动脉可拆卸球囊放置）。由于独特的血管挑战，其他病例采用手术和血管内联合方法进行治疗。第二个是一名71岁的女性，患有自发性右侧CCF，其颈动脉窦通过SOV的椎管切开而被进入并栓塞。第三例是一名有症状的七十岁男子,自发性双侧CCF。经动脉和经静脉血管内途径不成功后，进行了经眶（颅内）SOV切除和插管以栓塞分流瘘。
血管内方法被充分描述为CCF的主要治疗方法，但并非对所有患者都是可能的。在个别血管解剖结构不适合经动脉或静脉介入或栓塞的情况下，手术和血管内联合入路可能是合适的。我们描述了3个案例，说明了CCF的干预范围，以及2名复杂患者的治疗技术方面，直接CCF，使用依赖于SOV切开和插管的栓塞方法。
