Transvenous embolization of the direct carotid-cavernous fistula via the pterygoid plexus: illustrative case.
direct carotid-cavernous fistula
pterygoid plexus
ruptured giant aneurysm
transvenous embolization
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
13 Mar 2023
13 Mar 2023
Historique:
received:
09
01
2023
accepted:
14
02
2023
entrez:
14
3
2023
pubmed:
15
3
2023
medline:
15
3
2023
Statut:
epublish
Résumé
Endovascular treatment is the mainstay of treatment for carotid-cavernous fistulas, but endovascular approaches vary widely. The authors report a rare case of a direct carotid-cavernous fistula with cranial nerve symptoms caused by rupture of a giant aneurysm in which selective transvenous embolization via the pterygoid plexus was performed. An 81-year-old man presented with headache and various progressive cranial nerve symptoms due to a direct carotid-cavernous fistula caused by a ruptured giant aneurysm. All the draining veins visualized on preoperative examination immediately before the treatment were occluded except for the pterygoid plexus. Therefore, the authors chose the dilated pterygoid plexus to approach the shunted pouch at the cavernous sinus and achieve shunt obliteration by selective embolization with coils and n-butyl cyanoacrylate. Careful study of the three-dimensional rotational images in the preoperative examination is important when considering the various approaches to surgery. The pterygoid plexus can be an effective venous approach route to reach the cavernous sinus area.
Sections du résumé
BACKGROUND
BACKGROUND
Endovascular treatment is the mainstay of treatment for carotid-cavernous fistulas, but endovascular approaches vary widely. The authors report a rare case of a direct carotid-cavernous fistula with cranial nerve symptoms caused by rupture of a giant aneurysm in which selective transvenous embolization via the pterygoid plexus was performed.
OBSERVATIONS
METHODS
An 81-year-old man presented with headache and various progressive cranial nerve symptoms due to a direct carotid-cavernous fistula caused by a ruptured giant aneurysm. All the draining veins visualized on preoperative examination immediately before the treatment were occluded except for the pterygoid plexus. Therefore, the authors chose the dilated pterygoid plexus to approach the shunted pouch at the cavernous sinus and achieve shunt obliteration by selective embolization with coils and n-butyl cyanoacrylate.
LESSONS
CONCLUSIONS
Careful study of the three-dimensional rotational images in the preoperative examination is important when considering the various approaches to surgery. The pterygoid plexus can be an effective venous approach route to reach the cavernous sinus area.
Identifiants
pubmed: 36916525
doi: 10.3171/CASE22558
pii: CASE22558
pmc: PMC10550643
doi:
pii:
Types de publication
Journal Article
Langues
eng
Références
AJNR Am J Neuroradiol. 2002 Aug;23(7):1156-9
pubmed: 12169474
J Neurosurg. 1995 Nov;83(5):838-42
pubmed: 7472552
AJR Am J Roentgenol. 1987 Sep;149(3):587-93
pubmed: 3497549
AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1240-6
pubmed: 12812963
World Neurosurg. 2020 Dec;144:e376-e379
pubmed: 32890847
AJNR Am J Neuroradiol. 2006 Aug;27(7):1535-40
pubmed: 16908575
Interv Neuroradiol. 2016 Oct;22(5):590-5
pubmed: 27298011
Neuroradiology. 1998 Mar;40(3):189-93
pubmed: 9580430
Interv Neuroradiol. 2007 Mar 15;13 Suppl 1:64-7
pubmed: 20566079
Neuroradiology. 2016 Dec;58(12):1181-1188
pubmed: 27796449
Neurosurgery. 2007 Sep;61(3 Suppl):81-5; discussion 85
pubmed: 17876236
AJNR Am J Neuroradiol. 2018 Dec;39(12):2301-2306
pubmed: 30385474
J Clin Neurosci. 2015 May;22(5):859-64
pubmed: 25682541
AJNR Am J Neuroradiol. 2010 Apr;31(4):651-5
pubmed: 19959773
Brain Sci. 2020 Aug 14;10(8):
pubmed: 32823885
J Neuroophthalmol. 2009 Mar;29(1):62-71
pubmed: 19458580
Neuroradiology. 2013 Aug;55(8):989-992
pubmed: 23644542
Radiol Case Rep. 2021 May 07;16(7):1806-1809
pubmed: 34025891