We read with interest the article by Goldberg et al1 in the June 1996 issue of the Archives and would like to comment on the importance of ophthalmologic monitoring during the procedure to detect and treat vision-threatening increases in orbital pressure.
We recently treated a 35-year-old white man with a spontaneous cavernous sinus-dural fistula. An arteriogram demonstrated poor venous access through the usual transcutaneous approaches. We were asked to provide access for a superior ophthalmic vein cannulation.
An anterior orbitotomy was performed while the patient was under general anesthesia, and the superior ophthalmic vein was isolated. A micropuncture introducer (4F Micropuncture Introducer, Cook Corp, Bloomington, Ind) was introduced. A microcatheter (Tracker-18, Target Therapeutics, Fremont, Calif) was placed through the introducer into the posterior cavernous sinus. Platinum microcoils were passed into the sinus. Approximately 1 hour after commencement of the procedure, increasing exophthalmos of the right eye was noted, along
Devoto MH, Egbert JE, Tomsick TA, Kulwin DR. Acute Exophthalmos During Treatment of a Cavernous Sinus-Dural Fistula Through the Superior Ophthalmic Vein. Arch Ophthalmol. 1997;115(6):823-824. doi:10.1001/archopht.1997.01100150825035