Management of Nontraumatic Vascular Shunts Involving the Cavernous Sinus

Mark J. Kupersmith, Alejandro Berenstein, In Sup Choi, Floyd Warren, Eugene Flamm

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

The authors managed 38 consecutive cases of nontraumatic vascular shunts involving the cavernous sinus. Selective angiography demonstrated I`.? carotid cavernous fistulas (CCFs) and 26 dural arteriovenous shunts (DAVSs). Visual disability occurred from glaucoma, venous retinopathy, optic neuropathy, or diplopia. Ten patients with slow-flow shunts and minimal dysfunction were treated medically to lower intraocular pressure (IOP) and/or instructed in manual compression of the internal carotid artery, ipsilateral to the lesion, using the contralateral hand. Percutaneous intraarterial embolization using detachable balloons, isobutylcyanoacrylate, or polyvinyl alcohol particles was successful in 16/18 DAVSs and 9/10 CCFs. The neuro-ophthalmic signs resolved in these 25 cases. Complications occurred in five patients. These included a transient hemiparesis, twelfth nerve palsy, unilateral nasal field loss, a pseudoaneurysm causing a third-nerve paresis, and temporary cavernous sinus thrombosis. Conservative therapy in mild cases and embolization in cases with visual disability or progressive signs are warranted.

Original languageEnglish (US)
Pages (from-to)121-130
Number of pages10
JournalOphthalmology
Volume95
Issue number1
DOIs
StatePublished - 1988

Keywords

  • dural arteriovenous malformation
  • embolization
  • spontaneous carotid cavernous fistula

ASJC Scopus subject areas

  • Ophthalmology

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