OBJECTIVE To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. METHODS One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. RESULTS Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. CONCLUSION Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.

中文翻译：

---

在3D颅骨重建覆盖物的荧光镜引导下直接经皮经眶穿刺，用于栓塞眼眶内和海绵窦硬脑膜动静脉瘘。

目的描述直接经皮经皮穿刺技术对选定的眶内和海绵窦硬脑膜动静脉瘘栓塞的方法，但传统的血管内技术无法对其进行治疗。方法于2012年经直接经皮经眶穿刺行眶内硬膜外瘘1例，海绵窦硬膜动静脉瘘5例，并对其临床资料进行回顾性分析。在具有三维（3D）颅骨重建覆盖物的荧光透视引导下，海绵状窦或眼静脉经眶上裂穿刺。然后，通过针头插入一个微导管，并在有或没有线圈的情况下注射injected玛瑙以栓塞瘘管。结果所有6例患者的瘘管完全闭塞。手术后，所有患者经历了短暂的眼眶肿胀，持续了三到五天。没有其他并发症发生。对三至六个月的六名患者进行的随访显示，其最初的神经眼科症状在五分之内得以缓解，其中一分的视力丧失未能恢复。六个月的随访血管造影未显示这些瘘管复发。结论直接经皮经眶穿刺为眶内和海绵窦硬脑膜动静脉瘘提供了一种选择，尤其是当常规的经静脉途径难以接近时。3D颅骨重建的覆盖物可以促进眶上裂的精确穿刺。对三至六个月的六名患者进行的随访显示，其最初的神经眼科症状在五分之内得以缓解，其中一分的视力丧失未能恢复。六个月的随访血管造影未显示这些瘘管复发。结论直接经皮经眶穿刺为眶内和海绵窦硬脑膜动静脉瘘提供了一种选择，尤其是当常规的经静脉途径难以接近时。3D颅骨重建的覆盖物可促进眶上裂的精确穿刺。在3至6个月内对6例患者进行了随访，发现5例患者的最初神经眼科症状得到缓解，其中1例的视力丧失未能恢复。六个月的随访血管造影未显示这些瘘管复发。结论直接经皮经眶穿刺为眶内和海绵窦硬脑膜动静脉瘘提供了一种选择，尤其是当常规的经静脉途径难以接近时。3D颅骨重建的覆盖物可促进眶上裂的精确穿刺。结论直接经皮经眶穿刺为眶内和海绵窦硬脑膜动静脉瘘提供了一种选择，尤其是当常规的经静脉途径难以接近时。3D颅骨重建的覆盖物可以促进眶上裂的精确穿刺。结论直接经皮经眶穿刺为眶内和海绵窦硬脑膜动静脉瘘提供了一种选择，特别是当常规的经静脉途径难以接近时。3D颅骨重建的覆盖物可以促进眶上裂的精确穿刺。