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Vol. 19. Issue 4.
Pages 338-342 (January 2008)
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Vol. 19. Issue 4.
Pages 338-342 (January 2008)
Embolización de fístula carótido cavernosa indirecta a través de la vena oftálmica superior
Embolization of indirect carotid-cavernous sinus fistula through the ophthalmic vein
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2006
J.F. Alén
, J. Campollo, J.J. Rivas, A. Lagares, B. Pascual, L. Jiménez-Roldán, R.D. Lobato
Servicio de Neurocirugía. Hospital 12 de Octubre. Madrid
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Resumen

Las fístulas carótido cevernosas (FCC) indirectas o durales son comunicaciones entre el seno cavernoso y ramas extradurales de la arteria carótida interna, la carótida externa o ambas. La mayoría de las FCC indirectas son idiopáticas y aparecen espontáneamente. Los síntomas pueden variar desde una leve inyección conjuntival y escleral hasta la reducción severa de la agudeza visual. En casos poco sintomáticos y sin drenaje leptomeníngeo, el tratamiento conservador estaría indicado inicialmente, pues existe la posibilidad del cierre espontáneo de la fístula. Cuando la sintomatología progresa, requieren algún tipo de tratamiento para cerrarla. Hoy en día, el tratamiento endovascular es el de elección, y la vía transvenosa, con sellado o empaquetado del SC, ha demostrado mayor efectividad que la transarterial. En la mayoría de los casos se puede acceder al SC a través del seno petroso inferior. Sin embargo, en ocasiones no es posible el acceso a la FCC por vía venosa transfemoral, siendo necesario un abordaje directo a la vena oftálmica superior (VOS). Presentamos un caso de FCC indirecta tratada mediante abordaje directo a la VOS y embolización del seno cavernoso.

Palabras clave:
Fístula carótido cavernosa
Fístula dural
Vena oftálmica superior
Abreviaturas:
FCC
VOS
SC
Summary

Indirect or dural carotid cavernous fistulas are abnormal connections between the cavernous sinus and meningeal branches of the external and/or internal carotid arteries. Most of them are idiopathic and occurs spontaneously. Symptoms vary from a tiny episcleral injection to a severe visual loss. Conservative therapy is recomended in cases with few symptoms and no leptomeningeal drainage, as spontaneous resolution is not infrequent. Whenever symptoms worsen, treatment of the fistula should be prescribed. Nowadays, transvenous endovascular treatment consisting of packing the cavernous sinus is the first choice. In most cases, cavernous sinus can be approached through the inferior petrosal sinus. However, sometimes that is not possible, and an approach directly through the superior ophthalmic vein could be necessary. We report a case of a patient with a dural carotid cavernous fistula treated with embolization of the cavernous sinus through the ophthalmic vein.

Keywords:
Carotid cavernous fistula
Dural fistula
Superior ophthalmic vein

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