✓ The authors report on a young woman with Ehlers—Danlos syndrome (EDS) Type IV in whom a spontaneous direct carotid—cavernous fistula (CCF) was treated by transvenous occlusion with regular and fiber-coated Guglielmi detachable coils. To the authors' knowledge, this is the first time this approach has been used in a patient with EDS. The different treatment options are discussed, and the literature on endovascular treatment of direct CCFs in EDS is reviewed.
Treatment of spontaneous carotid—cavernous fistula in Ehlers—Danlos syndrome by transvenous occlusion with Guglielmi detachable coils
Case report and review of the literature
Andrew A. Kanner, Shimon Maimon and Zvi H. Rappaport
Khalil Salame, Shimon Maimon, Gilad J. Regev, Tali Jonas Kimchi, Akiva Korn, Laurence Mangel and Zvi Lidar
Preoperative embolization is performed before spine tumor surgery when significant intraoperative hemorrhage is anticipated. Occlusion of radicular and segmental arteries may result in spinal ischemia. The goal of this study was to check whether neurophysiological monitoring during preoperative angiography in patients scheduled for total en bloc spondylectomy (TES) of spine tumors improves the safety of vessel occlusion.
This was a case series study of patients who underwent tumor embolization under somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in preparation for TES in treating spine tumors. The angiography findings, the embolized vessels, and the results are presented.
Five patients whose ages ranged from 33 to 75 years and who had thoracic spine tumors are reported. Four patients suffered from primary tumor and 1 patient had a metastatic tumor. Radicular arteries at the tumor level, 1 level above, and 1 level below were permanently occluded when SSEPs and MEPs were preserved during temporary occlusion. No complications were encountered during or after the angiography procedure and embolization.
Temporary occlusion with electrophysiological monitoring during preoperative angiography may improve the safety of permanent radicular artery occlusion, including the artery of Adamkiewicz in patients undergoing TES for the treatment of spine tumors.