gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Retrograde coiling of a carotid cavernous sinus fistula via a direct microsurgical cortical vessel approach: Introduction of a combined microsurgical endovascular treatment

Meeting Abstract

  • H.J. Heiroth - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • B. Turowski - Institut für Radiologie, Heinrich-Heine-Universität Düsseldorf
  • N. Etminan - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • H.J. Steiger - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • D. Hänggi - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 011

doi: 10.3205/11dgnc232, urn:nbn:de:0183-11dgnc2326

Published: April 28, 2011

© 2011 Heiroth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: A 42-year-old patient suffered increasing left-sided proptosis, chemosis and impaired sight for five months. Additionally, he reported a pulsatile bruit. Digital subtraction angiography revealed a carotid cavernous sinus (CCS) fistula, Barrow type III, with main drainage into the sphenoparietal sinus and therefore selected for endovascular treatment. However, the endovascular access was not safely possible, neither from the arterial nor the venous route; thus, a combined transcranial endovascular approach was deemed as the most promising treatment for this patient.

Methods: A left pterional custom-tailored craniotomy was performed by the neurosurgeon using CT- navigation guidance. The major draining vein was identified and dissected. Additionally, a venotomy for the placement of a 4F-catheter was performed. The patient was then transferred to the angio suite, and the CCS was obliterated with platinum coils by the endovascular surgeon.

Results: Due to the direct intracranial venous access, the fistula was completely obliterated. After initial diplopia due to an incomplete palsy of the left abducens nerve, the patient recovered fully after three weeks. The initial symptoms, especially the proptosis and bruit regressed completely.

Conclusions: The present case report illustrates a successfully combined microsurgical and endovascular treatment in a patient suffering from a symptomatic carotid cavernous sinus fistula. Probably, especially in this type of pathology, combined strategies are of real benefit.