Endovascular treatment of carotid cavernous fistulae (CCF). Direct venous puncture using road mapping in dural CCF

IntroductionEndovascular treatment offers different options to treat CCF by less invasive approach avoiding morbidity and residual fistulas. The choice depends on the anatomy of the fistula and operator/Institutional preferences.ObjectiveDescribe options in endovascular treatment of Barrow Type A and Type D Carotid Cavernous fistulas (CCF).Patients and methodsWe report 10 cases of carotid cavernous fistula (CCF) that received endovascular treatment using coils and liquid embolic materials. Seven cases Barrow Type A, done through an arterial approach and three cases Barrow Type D, done through venous approach. The cavernous sinus in Type D cases was approached via the inferior petrosal sinus in one case and the other two cases by direct puncture of the facial and supra-orbital veins using road mapping. Using road mapping in venous approach to treat CCF is not reported in the literature before.ResultsSuccessful obliteration of the fistula was achieved in all cases with transient VI nerve palsy in one case and post procedure ophthalmic vein thrombosis in another.ConclusionWith the observed favorable outcomes and lack of significant procedural morbidity, direct puncture of the facial and supra-orbital veins using road mapping to reach the cavernous sinus, might be an addition in the armamentarium available for endovascular treatment of CCF.