Turkish Neurosurgery
Indocyanine green videoangiographic-guided cannulation of the superior ophthalmic vein for endovascular treatment of carotid cavernous fistulas
Francesco Acerbi1, Giuseppe Faragò1, Morgan Broggi1, Claudio Cavallo1, Michela Ranieri1, Valentina Caldiera1, Elisa Ciceri1, Paolo Ferroli1
1Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery, Milan,
DOI: 10.5137/1019-5149.JTN.18213-16.1

Backgorund Direct exposure and cannulation of superior ophthalmic vein (SOV) provides an alternative access to reach the cavernous sinus for carotid-cavernous fistula (CCF) embolization, when classic transvenous routes through inferior petrosal sinus (IPS) or facial vein are not feasible. We have used indocyanine green (ICG) videoangiography to study intraoperatively the flow inside the SOV in two cases of indirect CCF. In this paper we report the operative technique and the result of ICG videoangiographic-guided cannulation of the SOV for endovascular treatment of CCF. Material and Methods In November 2014, 2 male patients of 59 and 66 years of age respectively, presented at our Institution with right decreased visual acuity, persistent binocular diplopia and painful ophthalmoplegia, chemosis and proptosis, due to right unilateral indirect CCF fistula. Endovascular transvenous approach failed in one case due to thrombosis of the inferior petrosal sinus (IPS) and the extreme tortuosity of the angular vein. In the other case it was considered unfeasible due to an unfavourable vascular angioarchitecture. For this reason, an ICG videoangiographic-guided cannulation of the SOV, followed by endovascular obliteration of the CCF, was performed. Results CCF was cured in both cases with this approach. No additional neurological deficits and no complications due to SOV cannulation were registered during the hospital stay. There were no fistula recurrences during the mean follow-up of 10 months. Conclusion ICG-videoangiography is a simple, fast and cost-effective technique that can be reliably applied in SOV cannulation for subsequent indirect CCF embolization.

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