Amelioration of acute orbital compartment syndrome following transvenous embolization for an indirect carotid-cavernous fistula: A case report. Issue 49 (December 2017)

• Record Type: Journal Article
• Authors: Hsieh, Yun-Hsiu; Weng, Tzu-Heng; Tai, Ming-Cheng; Chien, Ke-Hung
• Other Names: Smolek. Michael section editor.
• Is Part Of: Medicine. Volume 96:Issue 49(2017)
• Publication Date: 2017-12
• Subjects: carotid cavernous fistula -- orbital compartment syndrome -- superior ophthalmic venous thrombosis -- transvenous embolization; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000009096
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Orbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed. Patient concerns: Here, we present a rare case of a 59-year-old patient who required a transvenous embolization of an indirect CCF and subsequently immediately developed an acute OCS. Diagnoses: An indirect CCF was revealed using brain magnetic resonance angiography and a transvenous embolization of the fistula was performed using coils. Post-embolization angiograms revealed an occlusion of the CCF. Interventions: After the development of a relative afferent pupillary defect and acute OCS, we performed a lateral canthotomy, superior and inferior cantholysis, and an orbital floor orbitectomy. Subsequently, visual acuity and intraocular pressure improved. Lessons: Our case is the first report of acute OCS occurring after transvenous embolization of a CCF that required further orbital floor decompression to prevent permanent visual loss. Moreover, our case demonstrates that acute OCS may rapidly develop after transvenous embolization due to superior ophthalmic venous (SOV) thrombosis and that an early intervention may reduce the risk of visual impairment.