Abstract：
Endovascular techniques have become the first-line treatment for carotid-cavernous fistulas (CCFs). Direct transorbital venous access may be used if anatomic constraints limit standard transarterial or transvenous access. We describe our institutional experience with the transorbital approach for Barrow Type A-D CCFs.
Patients with CCFs undergoing transorbital endovascular treatment at our institution between 2017 and 2019 were retrospectively reviewed. Demographic, treatment, and outcome data were collected.
Eight patients met inclusion criteria, 4 female and 4 male patients. The mean age was 43 years, with 6 right-sided CCF and 2 left-sided CCFs. Symptoms were present for an average of 1.5 months before treatment. All patients presented with eye pain and subjective visual changes. Seven (87.5%) patients presented with proptosis, 6 (75%) patients had elevated intraocular pressure (IOP), and 3 (37.5%) patients had ophthalmoplegia. Six CCFs (75%) were spontaneous, and 2 CCFs (25%) were traumatic. Barrow types were A (n = 1), B (n = 1), C (n = 1), and D (n = 5). All patients underwent direct percutaneous transorbital embolization with coils followed by Onyx. Three patients had undergone prior transarterial and/or transvenous treatment. A radiographic cure was obtained in all patients after direct transorbital embolization. After CCF cure, cranial nerve palsies resolved in 66.7% of patients, visual acuity in the affected eye was improved or stable in 75% of patients, and IOP had normalized in 85.7% of patients. Proptosis improved in all patients, with complete resolution in 75%.
Direct transorbital embolization is a safe and potentially curative treatment for all 4 Barrow types of CCFs.
Patients with CCFs undergoing transorbital endovascular treatment at our institution between 2017 and 2019 were retrospectively reviewed. Demographic, treatment, and outcome data were collected.
Eight patients met inclusion criteria, 4 female and 4 male patients. The mean age was 43 years, with 6 right-sided CCF and 2 left-sided CCFs. Symptoms were present for an average of 1.5 months before treatment. All patients presented with eye pain and subjective visual changes. Seven (87.5%) patients presented with proptosis, 6 (75%) patients had elevated intraocular pressure (IOP), and 3 (37.5%) patients had ophthalmoplegia. Six CCFs (75%) were spontaneous, and 2 CCFs (25%) were traumatic. Barrow types were A (n = 1), B (n = 1), C (n = 1), and D (n = 5). All patients underwent direct percutaneous transorbital embolization with coils followed by Onyx. Three patients had undergone prior transarterial and/or transvenous treatment. A radiographic cure was obtained in all patients after direct transorbital embolization. After CCF cure, cranial nerve palsies resolved in 66.7% of patients, visual acuity in the affected eye was improved or stable in 75% of patients, and IOP had normalized in 85.7% of patients. Proptosis improved in all patients, with complete resolution in 75%.
Direct transorbital embolization is a safe and potentially curative treatment for all 4 Barrow types of CCFs.
摘要：
目的：血管内技术已成为颈动脉海绵窦瘘（CCF）的一线治疗方法。如果解剖约束限制了标准的经动脉或经静脉通路，则可以使用直接的经眶静脉通路。我们描述了我们对BarrowA型-DCCF的跨轨道方法的机构经验。
方法：回顾性分析2017年至2019年在我院接受经眶腔内治疗的CCF患者。人口统计,治疗,并收集结果数据。
结果：8例患者符合纳入标准，4名女性患者和4名男性患者。平均年龄是43岁,有6个右侧CCF和2个左侧CCF。症状在治疗前平均出现1.5个月。所有患者均出现眼痛和主观视觉改变。7例（87.5%）患者出现眼球突出，6例（75％）患者眼压升高（IOP），3例（37.5%）患者有眼肌麻痹。六个CCF（75％）是自发的，2个CCF（25％）是创伤性的。巴罗类型为A(n=1)，B(n=1),C(n=1),和D(n=5)。所有患者均接受直接经皮经眶栓塞，然后使用线圈和Onyx。三名患者先前经历了经动脉和/或经静脉治疗。直接经眶栓塞后，所有患者均获得了影像学治愈。CCF固化后,66.7%的患者颅神经麻痹得到缓解,75%的患者患眼视力得到改善或稳定，85.7%的患者眼压恢复正常。所有患者的前突都得到了改善，具有75%的完整分辨率。
结论：对于所有4种Barrow类型的CCF，直接经眶栓塞是一种安全且潜在治愈的治疗方法。
方法：回顾性分析2017年至2019年在我院接受经眶腔内治疗的CCF患者。人口统计,治疗,并收集结果数据。
结果：8例患者符合纳入标准，4名女性患者和4名男性患者。平均年龄是43岁,有6个右侧CCF和2个左侧CCF。症状在治疗前平均出现1.5个月。所有患者均出现眼痛和主观视觉改变。7例（87.5%）患者出现眼球突出，6例（75％）患者眼压升高（IOP），3例（37.5%）患者有眼肌麻痹。六个CCF（75％）是自发的，2个CCF（25％）是创伤性的。巴罗类型为A(n=1)，B(n=1),C(n=1),和D(n=5)。所有患者均接受直接经皮经眶栓塞，然后使用线圈和Onyx。三名患者先前经历了经动脉和/或经静脉治疗。直接经眶栓塞后，所有患者均获得了影像学治愈。CCF固化后,66.7%的患者颅神经麻痹得到缓解,75%的患者患眼视力得到改善或稳定，85.7%的患者眼压恢复正常。所有患者的前突都得到了改善，具有75%的完整分辨率。
结论：对于所有4种Barrow类型的CCF，直接经眶栓塞是一种安全且潜在治愈的治疗方法。
