A safe technique for the precise localization of carotid-cavernous fistula during balloon obliteration

Technical note

Herbert L. CaresNeurosurgical Service and Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, and the Dent Foundation, Millard Fillmore Hospital, Buffalo, New York

Search for other papers by Herbert L. Cares in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Glen H. RobersonNeurosurgical Service and Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, and the Dent Foundation, Millard Fillmore Hospital, Buffalo, New York

Search for other papers by Glen H. Roberson in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Walter GrandNeurosurgical Service and Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, and the Dent Foundation, Millard Fillmore Hospital, Buffalo, New York

Search for other papers by Walter Grand in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
L. Nelson HopkinsNeurosurgical Service and Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, and the Dent Foundation, Millard Fillmore Hospital, Buffalo, New York

Search for other papers by L. Nelson Hopkins in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

✓ The authors report a technique to precisely localize a fistulous opening in the carotid artery. The patient is heparinized and a Prolo catheter is introduced into the internal carotid artery and inflated distal to the approximate site of the fistula. Heparinization allows the balloon to be inflated long enough to obtain and analyze high-quality angiography film without fear of thromboembolism generated by the temporary balloon occlusion. Contrast material injected through the Prolo catheter proximal to the balloon reveals a small segment of cavernous carotid artery between the inflated balloon distally and the fistula proximally. The venous structures are now only faintly opacified and cannot obscure the morbid anatomy of the exact fistulous tear in the carotid artery. If the balloon is placed exactly opposite to the site of the fistula, a standing, stagnant column of dye forms a cast of the cavernous, petrous, and cervical carotid artery. Once the fistula is localized with this method, it may be obliterated by any therapeutic means preferred. If the Prolo catheter is used for intraluminal occlusion, then a transfemoral contralateral carotid angiogram is done before the heparin is reversed to confirm that the balloon has not been placed proximal to the fistula.

  • Collapse
  • Expand
  • 1.

    Cares HL, , Crowell R, & Papadakis N, et al: Consecutive bilateral carotid-cavernous fistulae: case report with unusual complications (In preparation) Cares HL, Crowell R, Papadakis N, et al: Consecutive bilateral carotid-cavernous fistulae: case report with unusual complications (In preparation)

    • Search Google Scholar
    • Export Citation
  • 2.

    Cares HL, , Hale JR, & Montgomery DB, et al: Laboratory experience with a magnetically guided catheter system. J Neurosurg 38:145154, 1973 Cares HL, Hale JR, Montgomery DB, et al: Laboratory experience with a magnetically guided catheter system. J Neurosurg 38:145–154, 1973

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Debrun G, , Lacour P, & Caron JP, et al: Inflatable and released balloon technique experimentation in dog — application in man. Neuroradiology 9:267271, 1975 Debrun G, Lacour P, Caron JP, et al: Inflatable and released balloon technique experimentation in dog — application in man. Neuroradiology 9:267–271, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Genton E: Guidelines for heparin therapy. Ann Intern Med 80:7782, 1974 Genton E: Guidelines for heparin therapy. Ann Intern Med 80:77–82, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Hosobuchi Y: Electrothrombosis of carotid-cavernous fistula. J Neurosurg 42:7685, 1975 Hosobuchi Y: Electrothrombosis of carotid-cavernous fistula. J Neurosurg 42:76–85, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Huber P: A technical contribution of the exact angiographic localization of carotid cavernous fistulas. Neuroradiology 10:239241, 1976 Huber P: A technical contribution of the exact angiographic localization of carotid cavernous fistulas. Neuroradiology 10:239–241, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Nussbaum M, & Mosches CB: Anticoagulants and anticoagulation. Med Clin North Am (5) 60:855869, 1976 Nussbaum M, Mosches CB: Anticoagulants and anticoagulation. Med Clin North Am (5)60:855–869, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Ojemann RG, , Crowell RM, & Roberson GH, et al: Surgical treatment of extracranial carotid occlusive disease. Clin Neurosurg 22:214263, 1975 Ojemann RG, Crowell RM, Roberson GH, et al: Surgical treatment of extracranial carotid occlusive disease. Clin Neurosurg 22:214–263, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Parkinson D: Carotid-cavernous fistula, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 237249 Parkinson D: Carotid-cavernous fistula, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 237–249

    • Search Google Scholar
    • Export Citation
  • 10.

    Prolo DJ, , Burres KP, & Hanbery JW: Balloon occlusion of carotid-cavernous fistula: introduction of a new catheter. Surg Neurol 7:209214, 1977 Prolo DJ, Burres KP, Hanbery JW: Balloon occlusion of carotid-cavernous fistula: introduction of a new catheter. Surg Neurol 7:209–214, 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Prolo DJ, & Hanbery JW: Treatment of carotid-cavernous fistula with catheter and balloon, in Morley RP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 250254 Prolo DJ, Hanbery JW: Treatment of carotid-cavernous fistula with catheter and balloon, in Morley RP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 250–254

    • Search Google Scholar
    • Export Citation
  • 12.

    Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125145, 1974 Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 586 325 5
Full Text Views 134 0 0
PDF Downloads 94 0 0
EPUB Downloads 0 0 0