New aesthetic approach to carotid cavernous sinus fistula for coil embolization.

Purpose: Transvenous embolization has become the treatment of choice for carotid cavernous sinus fistula (CCSF). We report a case of coil embolization of CCSF using a superior ophthalmic vein (SOV) approach.

Methods: We have used the SOV approach on 5 patients with dural arteriovenous fistulas involving the cavernous sinus. Diagnostic facial contrast-enhanced computed tomography, brain magnetic resonance imaging, and contrast angiography and cerebral angiography revealed a CCSF. Fistula occlusion using an external SOV approach of CCSF was performed.

Results: Angiography performed on both sides demonstrated complete occlusion of the fistula. We had good result with coil embolization via SOV approach. We have a 100% success rate with no major complication.

Conclusions: The coil embolization via SOV approach is a safe and effective treatment. The SOV can be channeled by allowing the insertion of detachable coils in the fistula. We suggest that there is need to training plastic surgeon to be experienced.