1
|
Zhou Z, Xu K, Yu J. Transfemoral trans-facial vein-superior ophthalmic vein to embolize cavernous sinus dural arteriovenous fistulas. Front Neurol 2023; 13:1078185. [PMID: 36712416 PMCID: PMC9877525 DOI: 10.3389/fneur.2022.1078185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal communication between the CS and dural arteries from the internal carotid artery and external carotid artery. CS-DAVFs are not uncommon. The preferred treatment for most CS-DAVFs is transvenous embolization (TVE), which can achieve a high cure rate with few complications. The trans-inferior petrous sinus (IPS) route from the internal jugular vein to the CS is the favorite and most direct route to perform TVE in the great majority of CS-DAVFs. However, when the trans-IPS route fails and if the facial vein (FV) is patent and dilated, transfemoral trans-FV-superior ophthalmic vein (SOV) embolization of the CS-DAVF can be attempted. However, the transfemoral trans-FV-SOV route to embolize CS-DAVFs is often challenging, and there is insufficient knowledge about it. Therefore, an updated review of the transfemoral trans-FV-SOV route to embolize CS-DAVFs is necessary, and this review includes our experience. The images in this review are from our institute without the dispute of copyright. Issues regarding the transfemoral trans-FV-SOV route to embolize CS-DAV were discussed, including the FV anatomy and variation, various TVE routes to access CS-DAVF, the procedure of the transfemoral trans-FV-SOV route to embolize CS-DAVF, difficulty, and solution of the transfemoral trans-FV-SOV route to embolize CS-DAVF, and complications and prognosis of transfemoral trans-FV-SOV to embolize CS-DAVF. By reviewing the transfemoral trans-FV-SOV route to embolize CS-DAVFs, we found that this route provides a valuable alternative to the other transvenous routes. A good prognosis can be obtained with the transfemoral trans-FV-SOV route to embolize CS-DAVFs in select cases.
Collapse
|
2
|
Guest W, Krings T. Transvenous Approaches to Embolization of Dural Arteriovenous Fistulae of the Cavernous Sinus. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:63-73. [PMID: 37502647 PMCID: PMC10370966 DOI: 10.5797/jnet.ra.2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/18/2021] [Indexed: 07/29/2023]
Abstract
Dural arteriovenous fistulae of the cavernous sinus (CS) (previously often referred to indirect carotid cavernous fistulas) are rare vascular shunts involving meningeal branches and osseous branches of the external or internal carotid arteries and the CS. They typically present with ocular symptoms including pain, conjunctival injection, and proptosis. Left untreated there may be a risk of vision loss, and fistulas with cortical venous reflux through either the deep or superficial venous system may cause intracranial venous congestion or hemorrhage. Endovascular embolization is the standard treatment, and while transarterial routes may appear possible, transarterial embolization has considerable risks of ischemic complications. Conversely, transvenous routes achieve a high rate of fistula occlusion with a low risk of peri-procedural morbidity. Procedural success depends on identification of the venous outflows from the fistula and localization of the fistulous point, to select the best route of access to the CS, including the inferior petrosal sinus (IPS), intercavernous sinus, or superior ophthalmic vein, among others. Even if the IPS is not visualized, it may be possible to recanalize it to gain access to the CS. Embolization can be performed with a combination of coils, fibered coils, and liquid embolic agents, focusing on occlusion of the fistulous point or blocking high-risk venous outflow pathways. In this review we will highlight procedural pearls and potential pitfalls and our typical approach to these lesions based on illustrative examples.
Collapse
Affiliation(s)
- Will Guest
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Division of Neuroradiology, Toronto Western Hospital, Toronto, ON, Canada
| |
Collapse
|
3
|
Transvenous embolization of a direct carotid-cavernous fistula through the pterygoid plexus approach. Radiol Case Rep 2021; 16:1806-1809. [PMID: 34025891 PMCID: PMC8120854 DOI: 10.1016/j.radcr.2021.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
We present a transvenous embolization technique for a direct carotid-cavernous fistula through the pterygoid plexus to the cavernous sinus which only 2 cases have been previously reported in the English literature. This method is appropriate when transarterial techniques or other attempts at transvenous access have failed due to vessel tortuosity, hypoplasia, stenosis, or occlusion. A middle-aged female patient presented with progressive left exophthalmos with conjunctiva chemosis and bruit after sustaining a falling injury. Digital subtraction angiography revealed Barrow type A carotid-cavernous fistula. The drainage route passed through a distal thrombosed superior ophthalmic vein that ended deep in the orbit. No other patent venous sinuses connected to the cavernous sinus, except for a small tract of pterygoid plexus. After failure of transarterial approach and other methods of transvenous access, we attempted to superselectly access to the cavernous sinus by applying transpterygoid technique with embolization using detachable coils. The transpterygoid venous approach to accessing the cavernous sinus represents an alternative approach when other techniques fail.
Collapse
|
4
|
Sato Y, Hattori K, Okamoto T, Fujitani S, Wada K, Saito T, Okumura T, Hatano H. Usefulness of an Electromagnetic Navigation System for Direct Percutaneous Puncture of the Superior Ophthalmic Vein. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:64-70. [PMID: 37503450 PMCID: PMC10370611 DOI: 10.5797/jnet.tn.2020-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/23/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of dural arteriovenous fistula (dAVF) at the cavernous sinus treated by direct puncture of the superior ophthalmic vein (SOV) using an electromagnetic navigation system. Case Presentation The case involved a 70-year-old male patient who presented with mild chemosis, proptosis, and abducens palsy of the right eye. In this case, we used an electromagnetic navigation system for direct puncture of the SOV. Angiographic obliteration of the fistula was confirmed and the visual symptoms recovered well after surgery. There were no complications associated with direct puncture of the SOV using the electromagnetic navigation system. Conclusion Direct puncture of the SOV to obliterate a dAVF is a possible alternative choice of treatment when the usual transvenous access route fails. To reduce the risk of complications, an electromagnetic navigation system is useful.
Collapse
Affiliation(s)
- Yoshiki Sato
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Kenichi Hattori
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Takeshi Okamoto
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Shigeru Fujitani
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Kentaro Wada
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Tsuyoshi Saito
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Taro Okumura
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Hisashi Hatano
- Department of Neurosurgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| |
Collapse
|
5
|
Oshita J, Sakamoto S, Okazaki T, Kuwabara M, Kurisu K. Access-route Visualization Using Ultrasonography and CT Angiography to Predict the Feasibility of Transvenous Embolization via the Facial Vein for Cavernous Sinus Dural Arteriovenous Fistulas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:373-380. [PMID: 37501667 PMCID: PMC10370907 DOI: 10.5797/jnet.oa.2020-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/07/2020] [Indexed: 07/29/2023]
Abstract
Objective Transvenous embolization (TVE) is an effective treatment for cavernous sinus dural arteriovenous fistulas (CS-DAVFs). The facial vein (FV) can be used as an access route for TVE when a trans-inferior petrosal sinus (IPS) approach is difficult. We evaluated the usefulness of combining ultrasonography (US) with computed tomography angiography (CTA) for confirming that the FV is a suitable access route for treating CS-DAVFs. Methods Trans-FV TVE was planned for five CS-DAVF patients in whom the shunt point was located in the posterior compartment of the CS and anterior venous drainage predominantly occurred via the superior ophthalmic vein (SOV). The anterior drainage route was examined with CTA and US. We reviewed the relationships between preoperative CTA/US findings and the accessibility of CS-DAVFs via the FV. Results The periorbital and perimandibular drainage pathways were clearly more visible on US than on CTA, and the cervical and thoracic drainage pathways were more visible on CTA than on digital subtraction angiography (DSA). CS-DAVFs were accessible via the FV when (1) the entire drainage pathway could be confirmed on CTA and US, (2) the periorbital and perimandibular pathways were unclear on CTA, but could be confirmed on US, or (3) the FV pathway drained into the internal jugular vein (IJV) or external jugular vein (EJV). On the other hand, TVE was challenging to perform via the FV when (1) the periorbital pathway was unclear on CTA and US, (2) the FV pathway drained into the brachiocephalic vein, or (3) the SOV thrombosed intraoperatively. In all five patients, TVE for CS-DAVFs performed via the FV or IPS was successful. Conclusion CTA and US are useful for confirming the anterior access route for trans-FV TVE for CS-DAVFs and predicting the feasibility of such treatment. Our findings suggest that CS-DAVFs can be accessed via the FV if the periorbital drainage pathway can be confirmed on US, even if the pathway is unclear on CTA.
Collapse
Affiliation(s)
- Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| |
Collapse
|
6
|
Brenna CTA, Priola SM, Pasarikovski CR, Ku JC, Daigle P, Gill HS, DeSerres JJ, Antonyshyn O, Da Costa L, Yang V. Surgical Sparing and Pairing Endovascular Interventions for Carotid-Cavernous Fistula: Case Series and Review of the Literature. World Neurosurg 2020; 140:18-25. [PMID: 32437988 DOI: 10.1016/j.wneu.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. In rare circumstances patients' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation. CASE DESCRIPTION We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. The first is a 35-year-old man with symptomatic, traumatic, right-sided CCF, treated with endovascular therapy (transarterial detachable balloon placement). The other cases were treated with contrasting surgical and endovascular combined approaches because of unique vascular challenges. The second is a 71-year-old woman with spontaneous right-sided CCF whose carotid sinus was accessed and embolized through a transpalpebral cutdown of the SOV. The third case is a 70-year-old man with symptomatic, spontaneous bilateral CCF. After unsuccessful transarterial and transvenous endovascular approaches, transorbital (intracranial) SOV cutdown and cannulation were performed to embolize the shunting fistula. CONCLUSIONS Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.
Collapse
Affiliation(s)
- Connor T A Brenna
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stefano M Priola
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Jerry C Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Daigle
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Harmeet S Gill
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Joshua J DeSerres
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Oleh Antonyshyn
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Leodante Da Costa
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
7
|
Gomez-Paz S, Vergara-Garcia D, Robinson M, Kicielinski KP, Thomas AJ, Ogilvy CS. Coil Embolization of a Carotid-Cavernous Fistula Through Superior Ophthalmic Venous Access via External Jugular Vein Puncture Approach. World Neurosurg 2019; 131:196. [PMID: 31421303 DOI: 10.1016/j.wneu.2019.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
Carotid-cavernous fistulas are vascular malformations that pose a risk for intracranial hemorrhage when there is documented cortical venous drainage. When possible, treatment with transvenous embolization has become the technique of choice since the late 1990s.1,2 We present a case of a patient with a carotid-cavernous fistula treated with venous coil embolization via a jugular venous approach. The patient was a 59-year-old female with a history of intense headaches. Initial magnetic resonance imaging showed congestion in the right cavernous sinus, and a diagnostic angiogram revealed a cavernous carotid fistula Thomas type 4.3,4 Given the presence of retrograde cortical venous drainage, we decided to treat the lesion. A femoral route for endovascular treatment was attempted, but it was unsuccessful in traversing the external jugular vein due to venous valves. We accessed the fistula through a direct puncture direct proximal approach,5 from the external jugular vein making our trajectory through the facial-angular-supraorbital vein, ultimately reaching the cavernous sinus. We then filled the sinus with coils to obliterate the fistula. The patient awakened neurologically intact, and a postoperative angiogram demonstrated complete occlusion of the lesion. The patient was discharged at postoperative day 1 without complications. In this video, we narrate the important details of this alternative when a traditional route is inaccessible (Video 1). Informed consent was obtained for the case illustrated; however, neither Institutional Review Board nor patient consent is required for the report of a single case in which no identifiable patient information is shared.
Collapse
Affiliation(s)
- Santiago Gomez-Paz
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Vergara-Garcia
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matt Robinson
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly P Kicielinski
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
8
|
Finding the Inferior Petrosal Sinus for Embolizing Cavernous Dural Arteriovenous Fistula Using Preoperative Computed Tomography Angiography. World Neurosurg 2019; 126:e1069-e1074. [PMID: 30878755 DOI: 10.1016/j.wneu.2019.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inferior petrosal sinus (IPS) has been commonly adopted as a route for embolizing cavernous dural arteriovenous fistula (cDAVF). According to previous anatomical studies, >90% of persons have an IPS. Because the exact confluence position of the IPS with an internal jugular vein can be difficult to obtain using preoperative digital subtraction angiography (DSA), catheterizing into the IPS during endovascular treatment can sometimes be very difficult. Because the anatomical information has not been attainable, this route has not been as widely used. Thus, methods remain to be developed to allow the IPS to play its due role in the embolization of cDAVF. METHODS Seven cases of cDAVF were diagnosed by DSA. The 7 patients also underwent preoperative computed tomography angiography (CTA) and were treated by transvenous embolization. RESULTS Compared with DSA, the confluence position of the IPS with the internal jugular vein was easier to find using preoperative CTA in 6 cases. Based on this anatomical information, 6 cases were successfully embolized via the IPS route and 1 via the superior ophthalmic vein route. CONCLUSIONS Detailed anatomical information of the IPS can be obtained from preoperative CTA images. Thus, CTA can help localize the IPS and allow for embolization of cDAVF via the IPS route.
Collapse
|
9
|
Ren Z, Wang S, Xu K, Mokin M, Zhao Y, Cao Y, Wang J, Qiu H, Agazzi S, van Loveren H, Zhao J. The working road map in a neurosurgical Hybrid Angio-Surgical suite------ development and practice of a neurosurgical Hybrid Angio-Surgical suite. Chin Neurosurg J 2018; 4:7. [PMID: 32922868 PMCID: PMC7393899 DOI: 10.1186/s41016-017-0108-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background The concept of a Hybrid Angio-Surgical Suite (HASS) has emerged as a solution to the complexity of cerebrovascular surgery and the need for immediate intraoperative feedback. When to use it, what cases are suitable for its use, who can use it and how to use it remain debatable. Objective Provide the information regarding the application of the HASS for hospital, neurosurgeon and interventionalist. Methods We review the literatures of case reports and studies on the use of the hybrid angio-sugical suite along with application of HASS in our own practice. Results Indications for using HASS on different types of cerebral vascular disease, including cerebral aneurysm, AVM, DAVF, carotid and vertebral stenosis/occlusion, are addressed. The application of HASS for other non-cerebral vascular diseases, such as trauma, spine and skullbase cases, is reviewed and discussed. Conclusion HASS has made many surgical procedures safer and many difficult or previously untreatable conditions much more tractable and cost-effective. Other than used in cerebral vascular disease, HASS has much more applications, such as trauma, spine and other neurosurgical diseases.
Collapse
Affiliation(s)
- Zeguang Ren
- Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL 33606 USA
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100050 China
| | - Kaya Xu
- Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL 33606 USA.,Department of Neurosurgery, Guiyang Medical University, Guiyang, 550004 China
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL 33606 USA
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100050 China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100050 China
| | - Jia Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Hancheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100050 China
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL 33606 USA
| | - Harry van Loveren
- Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL 33606 USA
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|
10
|
Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus Through Percutaneous Ultrasound-Guided Puncture of the Facial Vein. World Neurosurg 2016; 99:812.e13-812.e20. [PMID: 28017743 DOI: 10.1016/j.wneu.2016.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The goal of dural arteriovenous fistula of the cavernous sinus treated with coils through ultrasound-guided access to the facial vein is to interrupt the fistulous communications and decrease the pressure in the cavernous sinus and consequently in the ophthalmic veins. The traditional approach in the treatment of these fistulae is transvenous endovascular occlusion of the cavernous sinus. Transvenous embolization has been proven to be safe and can provide complete and permanent occlusion of the fistula in a single session. The most commonly used venous pathway is the inferior petrosal sinus, but, if it is inaccessible, then, the superior ophthalmic vein is considered; nonetheless, it can require a surgical exposure. Other pathways include the transfemoral transfacial vein. An arterial approach is considered usually when venous approach pathways fail. Arterial occlusion of feeders supplying the fistula is associated with a greater risk of embolic complications. CASE DESCRIPTION We report a case of dural arteriovenous fistula of the cavernous sinus treated with coils through ultrasound-guided access to the facial vein. CONCLUSIONS We propose an alternative pathway when the conventional transvenous approach through the inferior petrosal sinus is excluded. An ultrasound-guided facial vein approach can be considered as a direct and safe alternative to reach the cavernous sinus and obtain exclusion of the fistula.
Collapse
|