Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis

J Neurointerv Surg. 2015 Dec;7(12):e39. doi: 10.1136/neurintsurg-2014-011454.rep. Epub 2014 Oct 31.

Abstract

Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST.

Keywords: Blood Flow; Coil; Intervention; Orbit; Vein.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cavernous Sinus Thrombosis / complications
  • Cavernous Sinus Thrombosis / diagnosis
  • Cavernous Sinus Thrombosis / surgery*
  • Embolization, Therapeutic / methods
  • Eye / blood supply
  • Female
  • Follow-Up Studies
  • Humans
  • Ocular Hypertension / diagnosis
  • Ocular Hypertension / etiology
  • Ocular Hypertension / surgery*
  • Ophthalmologic Surgical Procedures / methods*
  • Vision Disorders / diagnosis
  • Vision Disorders / etiology
  • Vision Disorders / surgery*