{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:17:15Z","timestamp":1761844635006,"version":"3.40.2"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:p>Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite.<\/jats:p><jats:p>This 82-year-old man presented with severe chemosis and proptosis of the right eye. Digital subtraction angiography revealed a Type B CCF with a feeding artery arising from the meningohypophyseal trunk of the right cavernous segment of the internal carotid artery. The CCF drained through a thrombosed right superior ophthalmic vein that ended deep in the orbit; there were no patent sinuses or venous plexuses connecting to the CCF. An endoscope-assisted transsphenoidal puncture created direct access to the nidus for embolization. Embolic agents were deployed through the puncture needle to achieve complete obliteration. Endoscope-assisted transsphenoidal puncture of the cavernous sinus is a feasible alternative to treat difficult-to-access CCFs in a neurosurgical hybrid operating suite.<\/jats:p>","DOI":"10.3171\/2016.5.jns16493","type":"journal-article","created":{"date-parts":[[2016,8,5]],"date-time":"2016-08-05T13:59:34Z","timestamp":1470405574000},"page":"327-331","source":"Crossref","is-referenced-by-count":5,"title":["Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite"],"prefix":"10.3171","volume":"127","author":[{"given":"Chien-Lun","family":"Tang","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Hsiang","family":"Liao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Hsien","family":"Chen","sequence":"additional","affiliation":[{"name":"Radiology, Neurological Institute, Taichung Veterans General Hospital; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih-Chieh","family":"Shen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Hsin","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsu-Tung","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuang-Seng","family":"Tsuei","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns16493","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"921","DOI":"10.3171\/jns.1994.81.6.0921","article-title":"Transethmoidal transsphenoidal approach for embolization of a carotid-cavernous fistula. 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