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Journal of Korean Neurosurgical Society 1999;28(12): 1810-1816.
GDC(Guglielmi Detachable Coil) Embolization for Carotid Cavernous Fistula - by Percutaneous Puncture of Superior Ophthalmic Vein -.
Kyoung Moon Kwak, Young Joon Kim, Bong Jin Park, Jung Nam Sung, Maeng Ki Cho
Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea.
For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described).
A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs).
The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days.
Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Key Words: Carotid cavernous fistula; Superior ophthalmic vein; Guglielmi detachable coil(GDC); Percutaneous puncture
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