Clinical Outcomes of the Superior Ophthalmic Vein Approach for Closure of Carotid Cavernous Fistulas

Precis: The transorbital superior ophthalmic vein (SOV) approach is a viable alternative for the management of carotid cavernous fistulas (CCFs) when conventional approaches through the femoral artery/vein, facial vein, or inferior petrosal sinus are unsuccessful. A review of 25 consecutive patients treated by this technique revealed successful clinical and angiographic outcomes with minimal orbital and no intracranial complications.

Background Statement: Transvenous embolization of CCFs via the SOV was first described in the 1980s. To date, the only published report evaluating outcomes of this technique included 10 patients. Herein, we study the largest cohort of 25 patients over two decades.

Purpose: This study aims to report outcomes of CCF closure through SOV cannulation.

Methods: Retrospective chart review of 25 consecutive patients.

Results: The median patient age was 67 years (range = 41–84) and majority were females (68%). The most common CCF type by arteriogram was Barrow type D (72%) and posterior cortical venous outflow was noted in 20%. The 22/25 (88%) fistulas were completely obliterated in one attempt. Ptosis was the most common postoperative complication (69%). Visual acuity worsened from light perception to no light perception in one patient. Another patient developed an orbital compartment syndrome, requiring canthotomy and cantholysis with full visual recovery. There were no cases of iatrogenic stroke, intracranial hemorrhage, or other intracranial complications.

Conclusion: The SOV approach is an excellent alternative for CCFs that have failed conventional approaches.

No conflict of interest has been declared by the author(s).