{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:09Z","timestamp":1787025729162,"version":"build-2736575974"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2012.1.focus123","type":"journal-article","created":{"date-parts":[[2012,4,26]],"date-time":"2012-04-26T15:08:28Z","timestamp":1335452908000},"page":"E13","source":"Crossref","is-referenced-by-count":32,"title":["The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx"],"prefix":"10.3171","volume":"32","author":[{"given":"Nohra","family":"Chalouhi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron S.","family":"Dumont","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavropoula","family":"Tjoumakaris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Fernando","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurij R.","family":"Bilyk","sequence":"additional","affiliation":[{"name":"Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Randazzo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard T.","family":"Dalyai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Rosenwasser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0320013","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.3174\/ajnr.A2702","article-title":"The use of onyx in different types of intracranial dural arteriovenous fistula","volume":"32","author":"Abud","year":"2011"},{"key":"b2-0320013","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3171\/jns.1985.62.2.0248","article-title":"Classification and treatment of spontaneous carotid-cavernous sinus fistulas","volume":"62","author":"Barrow","year":"1985"},{"issue":"1 Suppl","key":"b3-0320013","series-title":"Neurosurgery","first-page":"ONS-E170","article-title":"Intraorbital arteriovenous fistulae of the ophthalmic veins treated by transvenous endovascular occlusion: technical case report","volume":"58","author":"Caragine","year":"2006"},{"key":"b4-0320013","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3174\/ajnr.A0817","article-title":"Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx","volume":"29","author":"Cognard","year":"2008"},{"issue":"1 Suppl Operative","key":"b5-0320013","series-title":"Neurosurgery","first-page":"75","article-title":"Transorbital endovascular embolization of dural carotid-cavernous fistula: access to cavernous sinus through direct puncture: case examples and technical report","volume":"68","author":"Dashti","year":"2011"},{"key":"b6-0320013","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"756","DOI":"10.3171\/jns.2005.103.4.0756","article-title":"Transvenous embolization for a purely intraorbital arteriovenous fistula. 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