Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

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  • 1 Department of Neurosurgery and
  • 2 Bobby R. Alford Department of Otolaryngology, Baylor College of Medicine, Houston, Texas
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The classic presentation of a carotid-cavernous fistula (CCF) is unilateral painful proptosis, chemosis, and vision loss. Just as the goal of treatment for a dural arteriovenous fistula (dAVF) is obliteration of the entire fistulous connection and the proximal draining vein, the modern treatment of CCF is endovascular occlusion of the cavernous sinus via a transvenous or transarterial route. Here, the authors present the case of a woman with a paracavernous dAVF mimicking the clinical and radiographic presentation of a CCF. Without any endovascular route available to access the fistulous connection and venous drainage, the authors devised a novel direct hybrid approach by performing an endoscopic endonasal transsphenoidal direct puncture and Onyx embolization of the fistula.

ABBREVIATIONS CCF = carotid-cavernous fistula; dAVF = dural arteriovenous fistula.

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Contributor Notes

Correspondence Peter Kan: Baylor College of Medicine, Houston, TX. ptkan@utmb.edu.

INCLUDE WHEN CITING Published online November 13, 2020; DOI: 10.3171/2020.7.JNS201737.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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