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Zhu H, Chang Y, Li C, Zhang L, Jiang C, Zhang Y, Mo D. Reconstructive treatment using stent placement for type IIa+b lateral sinus dural arteriovenous fistulas complicated with sinus occlusion. Clin Neurol Neurosurg 2024; 245:108515. [PMID: 39178636 DOI: 10.1016/j.clineuro.2024.108515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Cognard type IIa+b dural arteriovenous fistulas (DAVFs) in the lateral sinuses are often complicated with venous sinus obstruction and accompanied by clinical symptoms and a risk of hemorrhage. The purpose of this study was to assess venous sinus stenting as a viable alternative treatment in complex lateral sinus DAVFs and examine its efficacy and safety. METHODS We retrospectively examined patients diagnosed with type IIa+b DAVF in the transverse or sigmoid sinus with associated venous sinus occlusion who were treated via stent placement between April 2017 and June 2019. RESULTS Six patients were included in this study. Three patients had DAVFs in both the transverse and sigmoid sinuses, two in the transverse sinus and confluence of sinuses, and one in the transverse sinus. The most common symptoms were headache, dizziness, and limb weakness. At the last follow-up, three patients had significant improvement, and three were asymptomatic. Angiograms performed immediately after the surgery showed restoration of the anterograde venous drainage in all patients. According to the follow-up angiography results, two DAVFs were completely obliterated, and four remained as stable type I DAVFs. Most patients had satisfactory venous sinus drainage, except one who had in-stent stenosis. CONCLUSIONS Stent placement can restore sinus patency, improve clinical symptoms, and decrease intracranial hemorrhage risk. This approach may be an effective option for treating type IIa+b lateral DAVFs complicated by sinus occlusion.
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Affiliation(s)
- Haoyu Zhu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yuzhou Chang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Changxuan Li
- Department of Neurosurgery, The first affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, China.
| | - Longhui Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Chuhan Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yupeng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Dapeng Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Lim J, Donnelly BM, Jaikumar V, Kruk MD, Kuo CC, Monteiro A, Siddiqi M, Baig AA, Patel D, Raygor KP, Snyder KV, Davies JM, Levy EI, Siddiqui AH. Transvenous embolization of noncavernous dural arteriovenous fistulas (dAVFs): A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199241234098. [PMID: 38414437 DOI: 10.1177/15910199241234098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries and veins within the dura mater. Various treatment modalities, such as surgical ligation, endovascular intervention, and radiosurgery, aim to close the fistulous connection. Although transvenous embolization (TVE) is the preferred method for carotid-cavernous fistulas, its description and outcomes for noncavernous dAVFs vary. This has prompted a systematic review and meta-analysis to comprehensively assess the effectiveness of TVE in treating noncavernous dAVFs, addressing variations in outcomes and techniques. METHODS We searched PubMed and Embase, spanning from the earliest records to December 2022, to identify pertinent English-language articles detailing the utilization of TVE. We focused on specific procedural details, outcomes, and complications in patients older than 18 years. The data collected and analyzed comprised the sample size, number of fistulas, publication specifics, presenting symptoms, fistula grades, and pooled rates of embolizations, outcomes, follow-up information, and complications. RESULTS From a total of 565 screened articles, 15 retrospective articles encompassing 166 patients spanning across seven countries met the inclusion criteria. Their Newcastle-Ottawa scores ranged from 6 to 8. Intraprocedural complication rate was 10% (95% confidence interval [CI] = 5.9-17.1) and in-hospital postprocedural complication rate was 5.4% (95% CI = 2.8-10.6). Prevalence of in-hospital mortality was 5.5% (95% CI = 2.9-10.6). Complication rate during follow-up was 8.6% (95% CI = 4.7-15.7) with fistula rupture occurring in 5.5% (95% CI = 2.6-11.6) of patients. Complete obliteration rate at final angiographic follow-up was 94.9% (95% CI = 90.3-99.9). Symptoms improved in 95% (95% CI = 89.8-100) of patients at final follow-up. CONCLUSION To our knowledge, we present the first meta-analysis assessing obliteration rates, outcomes, and complications of TVE for dAVFs. Our analysis highlights the higher (>90%) complete obliteration rates. Large prospective multicenter studies are needed to better define the utility of TVE for noncavernous dAVFs.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Marissa D Kruk
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Devan Patel
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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3
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Su X, Song Z, Tu T, Ye M, Zhang H, Ma Y, Zhang P. Isolated sinus dural arteriovenous fistulas: a single-center experience in 44 patients. Acta Neurochir (Wien) 2024; 166:96. [PMID: 38383924 DOI: 10.1007/s00701-024-06000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Isolated sinus dural arteriovenous fistulas (DAVFs) constitute a rare and distinctive subtype of DAVF, typically found in small case numbers or case reports. The optimal treatment for this DAVF type remains unclear. OBJECTIVE This study aims to further detail the treatment outcomes of isolated sinus DAVFs in a sizable cohort from a single center. METHODS A retrospective study was undertaken on a consecutive series of patients with isolated sinus DAVFs treated at a single institution from 2002 to 2022. The article delineates the clinical presentation, angiographic features, treatment strategy, clinical and angiographic outcomes, and complications. RESULTS The cohort consisted of 31 males and 13 females, with an average age of 52.0 ± 15.5 years (range, 16-83). The success rate for trans-arterial embolization (TAE) was 97.3% (36/37). Transvenous embolization (TVE) with the reopening technique was successful in 3 of 4 patients (75.0%). Two open burr-hole TVE cases (66.7%, 2/3) and one surgery (100%) resulted in immediate complete closure of the fistula. Immediate complete occlusion was achieved in 93.2% (41/44) of cases. There was one major complication (2.3%, 1/44) and two fistulas recurred (9.5%, 2/21). CONCLUSIONS The majority of isolated sinus DAVFs can be effectively treated with TAE using Onyx. TVE and surgery serve as alternative techniques when arterial access is deemed inappropriate or when complete occlusion cannot be attained with TAE. Complete embolization of isolated sinus DAVFs by TAE can typically be achieved without delay.
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Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- , Beijing, China.
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- , Beijing, China.
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- , Beijing, China.
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Su X, Song Z, Zhang H, Ma Y, Zhang P. Correspondence on 'Embolization strategies for intracranial dural arteriovenous fistulas with an isolated sinus: a single-center experience in 20 patients' by Hendriks et al. J Neurointerv Surg 2024; 16:327-328. [PMID: 37714537 DOI: 10.1136/jnis-2023-020932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Yamamoto D, Shibahara I, Koizumi H, Niki J, Ishima D, Usui R, Kimura A, Oikawa J, Hide T, Kumabe T. Angiographic evaluation of the distance from the top of the jugular bulb to the inferior petrosal sinus-internal jugular vein junction: simple classification and identification method for the orifice of the non-visualized inferior petrosal sinus during neuroendovascular surgery. Acta Neurochir (Wien) 2023; 165:4095-4103. [PMID: 37945999 DOI: 10.1007/s00701-023-05887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The inferior petrosal sinus (IPS) is the transvenous access route for neurointerventional surgery that is occasionally undetectable on digital subtraction angiography (DSA) because of blockage by a clot or collapse. This study was aimed at analyzing the distance from the jugular bulb (JB) to the IPS-internal jugular vein (IJV) junction and proposing a new anatomical classification system for the IPS-IJV junction to identify the non-visualized IPS orifice. METHODS DSA of 708 IPSs of 375 consecutive patients were retrospectively investigated to calculate the distance from the top of the JB to the IPS-IJV junction, and a simple classification system based on this distance was proposed. RESULTS The median distance from the top of the JB to the IPS-IJV junction was 20.8 ± 14.7 mm. Based on the lower (10.9 mm) and upper (31.1 mm) quartiles, IPS-IJV junction variants were: type I, 0-10 mm (22.3%); type II, 11-30 mm (45.8%); type III, > 31 mm (23.9%); and type IV, no connection to the IJV (8.0%). Bilateral distances showed a positive interrelationship, with a correlation coefficient of 0.86. The bilateral symmetry type (visualized IPSs bilaterally) according to our classification occurred in 267 of 300 (89.0%) patients. CONCLUSIONS In this study, the IPS-IJV junction was located far from the JB (types II and III), with a higher probability (69.6%). This distance and the four-type classification demonstrated high degrees of homology with the contralateral side. These results would be useful for identifying the non-visualized IPS orifice.
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Affiliation(s)
- Daisuke Yamamoto
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Jun Niki
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Daisuke Ishima
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ryo Usui
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ayato Kimura
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
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Akaike N, Ikeda H, Takada K, Uezato M, Kinosada M, Kurosaki Y, Chin M. Cavernous sinus dural arteriovenous fistula embolized through an occluded superior petrosal sinus: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE23143. [PMID: 37354434 PMCID: PMC10550532 DOI: 10.3171/case23143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Transvenous embolization for cavernous sinus (CS) dural arteriovenous fistulas (CS-DAVFs) with limitations of the major access routes to the CS is challenging. OBSERVATIONS A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS. The left inferior petrosal sinus and internal jugular vein were occluded, and no drainage route from the left superior ophthalmic vein was seen. The anterior segment of the left superior petrosal sinus (SPS) was occluded, but the posterior segment was not. Microangiography from the posterior segment of the left SPS showed a beak-like orifice in the anterior segment of the left SPS toward the left CS. A micro-guidewire was guided through the beak-like orifice, and the microcatheter was advanced into the left CS. The left CS was packed and the DAVF was occluded. LESSONS Transvenous embolization through an occluded SPS may be an option in the endovascular treatment of CS-DAVFs. Penetration along the beak-like orifice of the occluded SPS visualized by venography at the blind end of the SPS may be useful in reaching the CS via the SPS.
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Affiliation(s)
- Natsuki Akaike
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kensuke Takada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
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Brunasso L, Casamassima N, Abrignani S, Sturiale CL, Incandela F, Giammalva GR, Iacopino DG, Maugeri R, Craparo G. Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication? Surg Neurol Int 2023; 14:65. [PMID: 36895234 PMCID: PMC9990788 DOI: 10.25259/sni_1113_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/03/2023] [Indexed: 03/11/2023] Open
Abstract
Background Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other "off-label" indications, including solitary or adjunctive treatment to coil embolization for direct (Barrow A type) carotid cavernous fistulas (CCFs). The use of liquid embolic agents still represents the first-line treatment for indirect CCFs. Typically, the ipsilateral inferior petrosal sinus or superior ophthalmic vein (SOV) is the preferred transvenous routes to access CCFs. In some cases, vessel tortuosity or different features make the endovascular access challenging, thus requiring different approaches and strategies. The aim of the study is to discuss rational and technical aspect in treating indirect CCFs referring to the most up-to-date literature. An alternative experience-based endovascular strategy with FD is described. Methods We report the case of a 54-year-old woman diagnosed with indirect CCF and treated with flow diverter stent. Results After multiple unsuccessful attempts at transarterial right SOV catheterization, a right indirect CCF fed by a single trunk at the ophthalmic origin from the internal carotid artery (ICA) was treated by ICA stand-alone FD. Blood flow was redirect and successfully reduced through the fistula, with immediately postprocedure improvement of the patient's clinical status (ipsilateral proptosis and chemosis). Ten-months radiological follow-up showed the complete obliteration of the fistula. No adjunctive endovascular treatment was performed. Conclusion FD appears a reasonable alternative stand-alone endovascular strategy also for selected difficult-to-access indirect CCFs, when all conventional routes are judged unfeasible. Further investigations will be necessary to better define and support this potential lesson-learned application.
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Affiliation(s)
- Lara Brunasso
- Neurosurgical Clinic, Azienda Ospedaliera Universitaria Policlinico (AOUP) "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo
| | - Nicola Casamassima
- Department of Neuroradiology, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Civico Hospital, Palermo
| | - Sergio Abrignani
- Department of Neuroradiology, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Civico Hospital, Palermo
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Palermo, Italy
| | - Francesca Incandela
- Department of Neuroradiology, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Civico Hospital, Palermo
| | - Giuseppe Roberto Giammalva
- Neurosurgical Clinic, Azienda Ospedaliera Universitaria Policlinico (AOUP) "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, Azienda Ospedaliera Universitaria Policlinico (AOUP) "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo
| | - Rosario Maugeri
- Neurosurgical Clinic, Azienda Ospedaliera Universitaria Policlinico (AOUP) "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo
| | - Giuseppe Craparo
- Department of Neuroradiology, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Civico Hospital, Palermo
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Deniwar MA, Kwon B, Song Y, Park JC, Lee DH. Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus. J Korean Neurosurg Soc 2022; 65:688-696. [PMID: 35853478 PMCID: PMC9452388 DOI: 10.3340/jkns.2021.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/12/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. METHODS In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. RESULTS Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. CONCLUSION The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.
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Affiliation(s)
- Mohamed Adel Deniwar
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Neurosurgery, Mansoura University Hospitals, Mansoura, Egypt
| | - Boseong Kwon
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yamaguchi I, Kanematsu Y, Shimada K, Yamamoto N, Miyake K, Miyamoto T, Sogabe S, Shikata E, Ishihara M, Yamamoto Y, Kuroda K, Takagi Y. Single-session hematoma removal and transcortical venous approach for coil embolization of an isolated transverse-sigmoid sinus dural arteriovenous fistula in a hybrid operating room: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE2267. [PMID: 35734231 PMCID: PMC9204917 DOI: 10.3171/case2267] [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: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dural arteriovenous fistula (DAVF) can present with massive hematoma, which sometimes requires emergent removal. Therefore, a surgical strategy for single-session hematoma removal and shunt occlusion in the same surgical field is important. OBSERVATIONS A 73-year-old man was transferred to the authors' hospital with a headache. Brain computed tomography (CT) revealed an intracerebral hematoma in the right temporoparietal lobe (hematoma volume 12 ml). A cerebral angiogram revealed a right isolated transverse-sigmoid sinus (TSS)-DAVF fed by the occipital artery and middle meningeal artery. There was cortical venous reflux into the Labbé vein and posterior parietal vein. Percutaneous transarterial and transvenous embolization were unsuccessful. The following day, his consciousness level acutely declined with a headache, and brain CT showed hematoma expansion (hematoma volume 41 ml) with a midline shift. Therefore, the authors performed single-session hematoma removal and a transcortical venous approach for coil embolization of an isolated TSS-DAVF in a hybrid operating room. His postoperative course was uneventful. No recurrence was observed 3 months postoperatively on cerebral angiography. LESSONS Single-session hematoma removal and a transcortical venous approach for coil embolization of an isolated TSS-DAVF is considered in cases with massive hematoma. This strategy is useful, considering recent developments in hybrid operating rooms.
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Affiliation(s)
| | | | | | - Nobuaki Yamamoto
- Neurology, and
- Advanced Brain Research, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Deniwar MA, Ahmad S, Eldin AE. Transarterial Embolization of Intracranial Arteriovenous Fistulas with Large Venous Pouches in the Form of Venous Outlet Ectasia and Large Venous Varix or Aneurysm : Two Centers Experience. J Korean Neurosurg Soc 2021; 65:30-39. [PMID: 34897263 PMCID: PMC8752892 DOI: 10.3340/jkns.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
Objective There are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers' experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome. Methods The authors' two institutions' databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included. Results Fifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0-2). Conclusions TAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.
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Affiliation(s)
- Mohamed Adel Deniwar
- Department of Neurosurgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Saima Ahmad
- Department of Diagnostic and Interventional Neuroradiology, Lahore General Hospital, Post Graduate Medical Institute, Ameer-ud-Din Medical College, Lahore, Pakistan
| | - Ashraf Ezz Eldin
- Department of Neurosurgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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Zhang Q, Xu XL, Sun YL, Wang ZW, Lai XL, Xiong Y. Bilateral cavernous sinus dural arteriovenous fistula with initial ocular symptom: A case report. Medicine (Baltimore) 2021; 100:e27892. [PMID: 34797337 PMCID: PMC8601348 DOI: 10.1097/md.0000000000027892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cavernous sinus dural arteriovenous fistula (CSDAVF) is a rare intracranial vascular malformation. Because of its complicated clinical manifestations, it is easy to miss or misdiagnose CSDAVF. PATIENT CONCERNS A 42-year-old female had chief complaint that the right eyeball had conjunctival congestion for half a year. She was given levofloxacin eye drops to treat the right eye with anti-inflammatory treatment, but the symptoms did not improve. Cranial magnetic resonance and cerebrovascular imaging showed that the right lateral rectus muscle was slightly enlarged, the right eyeball was prominent, but there was no abnormality in the brain. DIAGNOSES Based on clinical and imaging examinations and digital subtraction angiography (DSA), she was diagnosed as low-flow CSDAVF. INTERVENTIONS The patient received interventional embolization with transvenous combined arterial approach using coils and Onyx liquid glue. OUTCOMES The patient's exophthalmos and congestion symptoms were improved. CONCLUSION DAS is the gold standard for the diagnose of CSDAVF. Intravascular embolization interventional therapy is an effective treatment for CSDAVF.
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Diana F, Frauenfelder G, Saponiero R, Iaconetta G, Romano DG. Transvenous Embolization with Ethylene Vinyl Alcohol and Arterial Flow Control of a Dural Arteriovenous Fistula of the Isolated Transverse Sinus. World Neurosurg 2021; 157:35. [PMID: 34626846 DOI: 10.1016/j.wneu.2021.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Dural arteriovenous fistulas draining into an isolated sinus often require a multimodal treatment, with transarterial and transvenous approaches.1-6 However, there is no consensus about the injection technique. Some authors suggest filling the sinus with coils in order to have a compact cast without unnecessary migration of the embolic material. We present a case of a patient with left temporal hemorrhage caused by a dural arteriovenous fistula on the isolated left transverse sinus. In this operative video we demonstrate how the arterial flow control during treatment allows us to obtain a compact cast of the embolic material inside the isolated sinus without coils (Video 1).
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy.
| | - Giulia Frauenfelder
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Renato Saponiero
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Giorgio Iaconetta
- Department of Neurosurgery, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
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Oliver BT, Kan P. Commentary: Direct Transverse Sinus Cannulation for Coil Embolization of a Transverse-Sigmoid Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E65-E66. [PMID: 33825877 DOI: 10.1093/ons/opab090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian T Oliver
- Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas, USA
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Hendriks EJ, Lynch J, Swaminathan SK, Nicholson P, Agid R, Radovanovic I, Pereira VM, terBrugge K, Krings T. Embolization strategies for intracranial dural arteriovenous fistulas with an isolated sinus: a single-center experience in 20 patients. J Neurointerv Surg 2021; 14:605-610. [PMID: 34083397 DOI: 10.1136/neurintsurg-2021-017652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/26/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (DAVFs) draining into an isolated sinus segment constitute a specific entity within the spectrum of cranial dural AV shunts, with under-reporting of their optimal treatment. OBJECTIVE To describe the multimodal treatment approach to isolated sinus DAVFs in a large single-center cohort. METHODS Retrospective analysis of adult patients with an isolated sinus DAVF treated at our institution between 2004 and 2020 was performed. Cases were analyzed for demographics, clinical presentation, angiographic findings, treatment techniques, angiographic and clinical outcomes, and complications. RESULTS Of 317 patients with DAVFs, 20 (6.3%) with an isolated sinus DAVF underwent treatment. Transarterial embolization was performed through the middle meningeal artery in 9 of 12 procedures, with a success rate of 66.7%. Transarterial glue embolization proved successful in two of five procedures (40%) and Onyx in six of seven procedures (85.7%). Transvenous embolization (TVE) with navigation via the occlusion into the isolated sinus was successful in seven out of nine procedures (77.8%). All three open TVE and one pure open surgical procedure gained complete closure of the fistula. There were two major complications. Complete occlusion of the fistula was eventually obtained in all cases (100%). CONCLUSIONS Isolated sinus DAVFs are always aggressive and require a multimodal approach to guarantee closure of the shunt. Transarterial treatment with Onyx achieves good results. Transvenous treatment appears equally successful, navigating into the occluded segment across the occlusion or via burr hole as backup.
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Affiliation(s)
- Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karel terBrugge
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Clinical outcomes of adjunct sinus stenting in dural arteriovenous fistulas : Role of flow restoration in steno-occlusion and cortical venous reflux. Clin Neuroradiol 2021; 32:455-464. [PMID: 34057563 DOI: 10.1007/s00062-021-01031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study investigated the clinical outcomes and follow-up results of venous sinus stenting (VSS) for constrictive dural sinus restoration in patients with intracranial dural arteriovenous fistulas (DAVFs). We hypothesized that this treatment would have durable benefits in such patients. METHODS Patients who underwent VSS for DAVFs with cortical venous reflux between January 2008 and June 2020 were identified after a retrospective review (n =18). Clinical and endovascular treatment data and follow-up information were reviewed. RESULTS The mean age of the 18 patients was 59.9 years. Stents were implanted in 10 previously occluded sinuses and 9 stenotic sinuses in addition to endovascular embolization. One patient received bilateral VSS. Subdural hemorrhage occurred in one patient after recanalization for embolization, followed by uneventful stenting. In 17 patients with clinical follow-up, the median follow-up time was 59.5 months (interquartile range 18 to 84 months). Of these, sixteen patients had follow-up vascular imaging, revealing AVF obliteration in 6 patients (38%) and stent patency in 11 (69%). Retreatment was performed for 8 (50%) patients. The mean follow-up modified Rankin scale score was 1.28. All patients had longstanding symptomatic improvement. CONCLUSION Restoration of sinus flow in DAVFs with cortical venous reflux through VSS has an acceptable complication rate and long-term symptomatic control; however, retreatment is often required, and stent occlusion is not uncommon.
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Kurabe S, Kumagai T, Abe H. A Comprehensive Analysis of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus: A Systematic Review. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:1-7. [PMID: 37503458 PMCID: PMC10370616 DOI: 10.5797/jnet.ra.2020-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/29/2020] [Indexed: 07/29/2023]
Abstract
Objective To evaluate published papers concerning dural arteriovenous fistula involving the superior sagittal sinus (SSS dAVF) treated with endovascular intervention. Methods A literature review was performed to identify studies reporting the clinical characteristics, vascular anatomy, endovascular techniques, embolic materials, angiographical result, and outcomes of SSS dAVF. Results The analysis consisted of 40 case reports or series, comprising a total of 51 cases of SSS dAVF treated with endovascular intervention. Clinical symptoms included hemorrhage (29.4%), infarction (17.6%), and seizure (7.8%). The arterial supply included the middle meningeal artery (MMA) (100%), superficial temporal artery (STA) (62.7%), and occipital artery (OA) (49.0%). Bilateral MMAs supplied in 78.4% of the cases. A pial arterial supply was observed in 21.6% of the cases. Stenosis or occlusion of the sinus was seen in 37.3% of the cases. The distribution of the Borden classification was as follows: I (7.8%), II (37.3%), and III (54.9%). The endovascular techniques were transvenous embolization (TVE) alone (11.8%), transarterial embolization (TAE) alone (74.5%), and a combination thereof (13.7%). The types of embolic materials for TAE were a coil (25.5%), n-butyl-2-cyanoacrylate (NBCA) (33.3%), and Onyx (45.1%). The arterial pedicles for TAE included MMA (86.3%), STA (17.6%), and OA (9.8%). Direct surgical exposure for the alternative endovascular access was performed to the SSS (5.9%), MMA (3.9%), STA (5.9%), and OA (3.9%). Sinus angioplasty with or without stenting was done in 9.8% of the cases. Balloon-assisted Onyx TAE was done with proximal flow control (7.8%), collateral devascularization (5.9%), and sinus protection (3.9%). Complete occlusion was achieved in 86.3% of the cases while the number of endovascular sessions varied among patients: single (74.5%), double (15.7%), and triple (9.8%). The rate of a postoperative modified Rankin Scale (mRS) score of 0-2 was 89.3%, with morbidity and mortality rates of 7.8% and 3.9%, respectively. Two patients died, possibly due to postoperative acute SSS occlusion. Conclusion The current systematic review disclosed several specific results, namely, the angioarchitectures of the SSS dAVF, the relationship between classification and hemorrhagic presentation, the diversity of treatment techniques, the association between the complete occlusion rate and the SSS condition, and the difficulty of achieving curable occlusion in a single session. These findings underscore the need for the development of endovascular techniques and devices to treat this challenging lesion. Improvements in adjunctive endovascular procedures, such as balloon-assisted techniques for Onyx TAE, may help support to the safe and effective obliteration of SSS dAVF.
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Affiliation(s)
- Satoshi Kurabe
- Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan
| | - Takashi Kumagai
- Department of Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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Roa JA, Dabus G, Dandapat S, Hasan D, Samaniego EA. Ethmoidal dural arteriovenous fistulas: endovascular transvenous embolization technique. J Neurointerv Surg 2020; 12:610. [DOI: 10.1136/neurintsurg-2019-015691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/03/2022]
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18
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Iampreechakul P, Wangtanaphat K, Lertbutsayanukul P, Wattanasen Y, Siriwimonmas S. Spontaneous Closure of a Cavernous Sinus Dural Arteriovenous Fistula with Spinal Perimedullary Drainage (Cognard V) during Attempted Transvenous Embolization. Asian J Neurosurg 2019; 14:1268-1274. [PMID: 31903376 PMCID: PMC6896619 DOI: 10.4103/ajns.ajns_277_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The authors describe a patient with spontaneous closure of a spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF), Cognard type V, during transvenous attempt. A 39-year-old woman experienced mild proptosis, redness of the left eye, and diplopia. Four months later, she developed left retro-orbital pain and left-sided headache. Cerebral angiography revealed the left CSDAVF exclusively draining into the superior petrosal sinus with subsequent drainage into the veins surrounding the medulla oblongata, and finally into the perimedullary spinal veins, classified as Cognard type V. The feeders arise from the dural branches of both the left external and internal carotid arteries. Following 2 h period of attempted transvenous embolization, the fistula disappeared spontaneously. Follow-up angiography obtained 6 months later confirmed complete resolution of the CSDAVF. At 2-year follow-up, the patient has remained clinically asymptomatic. The mechanism of thrombosis in this fistula related to the endovascular procedure. We speculated that putting the wire tip in the draining vein may induce the spontaneous thrombosis in the venous side. In addition, precipitating factors may include small, low-flow fistula, and pre-existing thrombosis.
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Affiliation(s)
| | | | | | - Yodkhwan Wattanasen
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
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Xu B, Wang Z, Bai W, Li T. Treatment of cavernous sinus dural arteriovenous fistula using different surgical approaches: Analysis of 32 consecutive cases. J Interv Med 2019; 2:118-122. [PMID: 34805884 PMCID: PMC8562270 DOI: 10.1016/j.jimed.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Here., we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach (IAA) or the inferior petrosal sinus approach (IPSA). METHODS The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed. All patients underwent routine diagnostic digital subtraction angiography (DSA) before surgery. Embolization was performed using the IPSA through the internal jugular vein or IAA, based on angioarchitectural features. RESULTS Of the 32 patients with CSDAVF, 24 underwent embolization treatment through the internal jugular vein-IPSA and 8 patients underwent treatment through IAA. Nineteen patients in the IPSA group experienced mild headache, which improved after specific treatment. The immediate postembolization angiographic results revealed complete occlusion in 26 cases (18 IPSA and 8 IAA) and almost complete occlusion in 6 cases (IPSA). Complications that occurred during the procedure included abducens nerve palsy (n = 1, IPSA) and prosopoplegia (n = 1, IAA). One patient developed tinnitus, which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA, whereas the symptoms of other patients all improved with no recurrence. CONCLUSIONS On the basis of the angioarchitectural features of CSDAVF, IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular, and when the microcatheter can easily reach the fistula through the artery. The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels. Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.
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Affiliation(s)
| | - Ziliang Wang
- Corresponding author. Department of Intervention, Henan Provincial People’s Hospital(The People’s Hospital of Zhengzhou University), No. 7 Weiwu Road, Zhengzhou City, Henan Province, 450003, PR China.
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Park KH, Park JS, Koh EJ, Lee JM. Gamma knife radiosurgery as an alternative treatment of Barrow type B carotid cavernous fistulas: A case report. Medicine (Baltimore) 2019; 98:e15803. [PMID: 31145311 PMCID: PMC6709095 DOI: 10.1097/md.0000000000015803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Barrow type B carotid-cavernous fistulas are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus; these types of dural fistulas can produce specific patterns of symptoms based on the pattern of venous drainage. PATIENT CONCERNS AND DIAGNOSES A 67-year-old man came to our hospital presenting with acute left orbital pain and double vision in the left eye. The diagnosis was carotid-cavernous fistula fed by the meningohypophyseal trunk and drained to the left superior ophthalmic vein. INTERVENTIONS AND OUTCOMES We planned gamma knife radiosurgery for the left cavernous sinus including fistula point as an alternative treatment. The orbital pain disappeared in 2 weeks, and all signs and symptoms in the left eye completely improved within 2 months. LESSONS Gamma knife radiosurgery may be an alternative treatment for carotid cavernous fistula. Furthermore, in patients with poor vascular access and no fatal presentation, this may be a reasonable first-line treatment option.
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Hosoo H, Tsuruta W, Nakai Y, Shiigai M, Sato M, Ito Y, Takigawa T, Marushima A, Ishikawa E, Yamamoto T, Matsumaru Y, Matsumura A. The Visualization Methods of Occluded Dural Sinus for Safe Transvenous Embolization of Dural AVFs. World Neurosurg 2019; 127:e337-e345. [PMID: 30904803 DOI: 10.1016/j.wneu.2019.02.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Transvenous embolization (TVE) via occluded sinus is one option for the treatment of dural arteriovenous fistulas. Understanding of the anatomical characteristics of the occluded sinus is difficult. It is often hard to reach the shunt point because of some risk of vessel perforation. METHODS We assessed usefulness of T1 Volumetric Isotropic TSE Acquisition (VISTA) Black Blood (BB) and 3D-T1 Fast Field Echo (FFE) for the evaluation and visualization of an occluded sinus. Evaluation of T1 VISTA BB and 3D-T1 FFE was performed preoperatively. TVE was performed via the occluded sinus while referring to the visualized reconstruction image. RESULTS Fourteen cases of TVE were performed between 2009 and 2015. The entire occluded sinus, including both thrombus and blood flow, was seen as the high-intensity region on 3D FFE T1 gadlinium (Gd). On the other hand, thrombus was seen as the iso- or high-intensity region and blood flow as the low-intensity region on T1 VISTA BB. The maximum intensity projection reconstruction image of 3D FFE T1Gd could visualize the whole occluded sinus and was useful for microcatheter maneuver. Total shunt obliteration was achieved in 13 cases (92.8%) except for one. CONCLUSIONS Magnetic resonance imaging evaluation of the occluded sinus using both T1 VISTA BB and 3D FFE T1Gd gives us valuable information of the occluded sinus regarding the development and the course of the occluded sinus, the length of the thrombotic occlusion, and leads to safer catheter maneuvers in TVE.
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Affiliation(s)
- Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan.
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center hospital, Ibaraki, Japan
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center hospital, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Hospital, Kanagawa, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Tanaka M. Embryological Consideration of Dural AVFs in Relation to the Neural Crest and the Mesoderm. Neurointervention 2019; 14:9-16. [PMID: 30827062 PMCID: PMC6433192 DOI: 10.5469/neuroint.2018.01095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 01/08/2023] Open
Abstract
Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.
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Affiliation(s)
- Michihiro Tanaka
- Department of Neurosurgery, Kameda Medical Center, Kamogawa, Japan
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Hou K, Ji T, Guo Y, Xu B, Xu K, Yu J. Current Status of Endovascular Treatment for Dural Arteriovenous Fistulas in the Superior Sagittal Sinus Region: A Systematic Review of the Literature. World Neurosurg 2019; 122:133-143. [DOI: 10.1016/j.wneu.2018.10.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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Bhogal P, AlMatter M, Hellstern V, Bäzner H, Ganslandt O, Henkes H, Aguilar Pérez M. High-Grade Dural Arteriovenous Fistulas : Use of Kaneka ED Coils with the Marathon Microcatheter for Transvenous Coil Embolization. Clin Neuroradiol 2018; 29:653-660. [PMID: 30167712 DOI: 10.1007/s00062-018-0724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVF) are commonly encountered lesions that can be treated both transvenously, transarterially or using a combined approach. OBJECTIVE Transvenous coil embolization of DAVF is a recognized treatment option but can be challenging. In this context this article presents clinical experience using the Kaneka ED10 ExtraSoft coils in combination with the Marathon microcatheter to treat high grade DAVF. The physical properties of these coils and the microcatheter were also determined. MATERIAL AND METHODS All patients with high grade DAVF treated with the Marathon and the Kaneka ED COIL ∞10 ExtraSoft coils were retrospectively identified. The clinical presentation, location, grade of the lesion, clinical and radiological follow-up data were recorded. Bench side studies were performed to determine the physical properties of the Marathon catheter in comparison to the SL10 and Headway Duo as well the maximum width of the Kaneka pusher wire in comparison to Hypersoft, Target and Axium Prime coils. RESULTS A total of 8 patients with 9 DAVF with 3 Cognard 3 and 6 Cognard 4 lesions were identified. All the DAVF's were occluded either at the end of the procedure or on follow-up imaging. On bench side tests the Marathon microcatheter had the most flexible distal tip and distal shaft in comparison to the SL10 and Headway Duo. The proximal shaft of the Marathon was stiffer than the SL10. The Kaneka ED COIL ∞10 ExtraSoft had the smallest distal width and were the only coils tested that could be deployed through a Marathon microcatheter. CONCLUSION The combination of the Marathon microcatheter and Kaneka ED COIL ∞10 ExtraSoft is useful for the treatment of high grade DAVF.
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Affiliation(s)
- P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany. .,Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.
| | - M AlMatter
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - V Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Aguilar Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Castro-Afonso LHD, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Abud DG. The routes for embolization of dural carotid cavernous fistulas when the endovascular approach is indicated as a first-line strategy. Interv Neuroradiol 2018; 25:66-70. [PMID: 30165774 DOI: 10.1177/1591019918796493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. METHODS A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. RESULTS The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%). CONCLUSIONS In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.
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Affiliation(s)
| | - Felipe Padovani Trivelato
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Rezende
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Cordeiro Ulhôa
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Daniel G Abud
- 1 Division of Interventional Neuroradiology, University of São Paulo, São Paulo, Brazil
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Shapiro M, Raz E, Litao M, Becske T, Riina H, Nelson PK. Toward a Better Understanding of Dural Arteriovenous Fistula Angioarchitecture: Superselective Transvenous Embolization of a Sigmoid Common Arterial Collector. AJNR Am J Neuroradiol 2018; 39:1682-1688. [PMID: 30115674 DOI: 10.3174/ajnr.a5740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to propose a conceptually new angioarchitectural model of some dural arteriovenous fistulas based on subset analysis of transverse and sigmoid type lesions. The "common collector" notion argues for convergence of multiple smaller caliber arterial vessels on a common arterial collector vessel within the sinus wall. Communication of this single collector (or constellation of terminal collectors) with the sinus proper defines the site of arteriovenous fistula, which can be closed by highly targeted embolization, preserving the sinus and avoiding unnecessary permeation of indirect arterial feeders. MATERIALS AND METHODS One hundred consecutive dural arteriovenous shunts were examined. Thirty-six transverse/sigmoid fistulas were identified within this group and analyzed for the presence of a common arterial collector as well as other parameters, including demographics, grade, treatment approach, and outcome. RESULTS A common collector was identified in nearly all Cognard type I lesions (15 fistulas with 14 single collector vessels seen) and progressively less frequently in higher grade fistulas. Identification of the common collector requires careful angiographic analysis, including supraselective and intraprocedural angiographies during treatment, and final embolic material morphology. CONCLUSIONS Detailed evaluation of imaging studies allows frequent identification of a vascular channel in the sinus wall, which we argue reflects a compound, common arterial channel (rather than a venous collector) with 1 or several discrete fistulous points between this vessel and the sinus proper. Targeted closure of this channel is often feasible, with sinus preservation and avoidance of embolic material penetration into arteries remote from fistula site.
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Affiliation(s)
- M Shapiro
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.) .,Neurology (M.S., M.L.)
| | - E Raz
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.)
| | | | - T Becske
- Department of Neurology (T.B.), Rochester Regional Health, Rochester, New York
| | - H Riina
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.).,Neurosurgery (H.R., P.K.N.), NYU School of Medicine, New York, New York
| | - P K Nelson
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.).,Neurosurgery (H.R., P.K.N.), NYU School of Medicine, New York, New York
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de Castro-Afonso LH, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Colli BO, Velasco-E-Cruz AA, Abud DG. Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes. J Neurointerv Surg 2017; 10:461-462. [PMID: 28823989 DOI: 10.1136/neurintsurg-2017-013318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown. OBJECTIVE To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF. METHODS A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients. RESULTS Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms. CONCLUSION In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Padovani Trivelato
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Rezende
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Cordeiro Ulhôa
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Augusto Velasco-E-Cruz
- Department of Ophthalmology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Akamatsu Y, Sato K, Endo H, Matsumoto Y, Tominaga T. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report. World Neurosurg 2017; 104:1046.e7-1046.e12. [PMID: 28408264 DOI: 10.1016/j.wneu.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. CASE DESCRIPTION We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. CONCLUSION The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy.
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Affiliation(s)
- Yosuke Akamatsu
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
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Castaño C, Remollo S, García-Sort R, Domínguez C, Terceño M. Treatment of Barrow type 'B' carotid cavernous fistulas with flow diverter stent (Pipeline). Neuroradiol J 2017; 30:607-614. [PMID: 28374616 DOI: 10.1177/1971400917695319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Carotid cavernous fistulas (CCFs) Barrow type 'B' are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option. Endovascular access through the superior ophthalmic vein (SOV) or inferior petrosal sinus have been widely used. The problem arises when there is no vascular access. For these cases, different approaches have been described, such as: direct access to the SOV; combining direct access to the SOV along with blind probing of the proximal occluded SOV; and a direct puncture of the cavernous sinus. But these techniques are very aggressive and can cause serious complications. As a result of the above, we describe a new alternative technique, which is effective and less invasive for the treatment of these special cases. Case reports We report two cases of Barrow type 'B' CCFs that did not have vascular access (neither arterial nor venous) to embolise fistulas with coils or glue, and which were successfully resolved with a flow diverter (Pipeline) stent in the internal carotid artery. To our knowledge, this treatment has not previously been described for this pathology. Conclusions The placement of a flow diverter stent in the internal carotid artery is an effective alternative technique in those cases of Barrow type 'B' CCFs that have no vascular access (neither venous nor arterial).
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Affiliation(s)
- Carlos Castaño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Sebastián Remollo
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Rosa García-Sort
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Carlos Domínguez
- 2 Neurosurgery Department, Hospital Universitario Germans Trias i Pujol, Spain
| | - Mikel Terceño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
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Guo WY, Lee CCJ, Lin CJ, Yang HC, Wu HM, Wu CC, Chung WY, Liu KD. Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study. AJNR Am J Neuroradiol 2017; 38:132-138. [PMID: 27765737 DOI: 10.3174/ajnr.a4960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. MATERIALS AND METHODS Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. RESULTS Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. CONCLUSIONS Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases.
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Affiliation(s)
- W-Y Guo
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C J Lee
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-J Lin
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-M Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - K-D Liu
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
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Cho YD, Rhim JK, Yoo DH, Kang HS, Kim JE, Cho WS, Han MH. Transvenous microguidewire looping technique for breach of ipsilateral inferior petrosal sinus occlusions en route to cavernous sinus dural arteriovenous fistulas. Interv Neuroradiol 2016; 22:590-5. [PMID: 27298011 DOI: 10.1177/1591019916653251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Transarterial access to dural arteriovenous fistulas (dAVFs) has been popularized by device improvements and novel embolic materials. However, this approach is limited in the cavernous sinus (CS) because of related complications and low cure rates. Although a transvenous approach, via ipsilateral inferior petrosal sinus (IPS), may be more suitable for CS-dAVFs, microcatheter delivery is occasionally impeded by ipsilateral IPS occlusion. Described herein is a microguidewire looping method to breach such occlusions, thus enabling access to CS lesions. METHODS A microcatheter is initially advanced into the IPS orifice, and a microguidewire is passed into the occluded IPS. Looping is easily achieved through the resistance met. With greater support of the guiding catheter, the microguidewire (still looped) is then advanced into the CS. When nearing the CS, the microcatheter is further reinforced, and it is navigated along the microguidewire into the CS. RESULTS This technique was applied in 10 instances of CS-dAVF with ipsilateral IPS occlusion, enabling ipsilateral access to the CS. In eight cases (80%), microdevice advancement was successful, culminating in effective transvenous coil embolization. Clinical and radiologic outcomes in all patients were excellent, with no delayed post-procedural cranial palsies. CONCLUSION This microguidewire looping technique enables safe and effective entry into the CS during transvenous coil embolization of CS-dAVFs with ipsilateral IPS occlusion.
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Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jong Kook Rhim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
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Tsai LK, Liu HM, Jeng JS. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Rev Neurother 2016; 16:307-18. [PMID: 26832225 DOI: 10.1586/14737175.2016.1149063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Abstract
BACKGROUND The distribution of intracranial dural AVFs (DAVFs) may be affected by the embryological bony structures that consist of membranous bone and endochondral bone. METHODS We retrospectively analyzed the distribution of the shunt points in 58 consecutive cases of DAVFs. Shunt points were identified with selective digital subtraction angiography, high-resolution cone beam computed tomography (CT), or three-dimensional rotation angiography. All the shunt points were plotted on the map of the skull base in relation to the topography of the endochondral bone and the membranous bone. If the shunt point was localized on the surface of endochondral bone, this was categorized as the endochondral bone group. If it was located on membranous bone, this was categorized as the membranous bone group. If the shunt point was independent from both bony structures, this was categorized as the independent group. FINDINGS In 55 of 58 cases, shunt points were identified angiographically. Three cases had multiple shunts. There were 33 shunt points (60 %) belonging to endochondral bone. In this group, 16 cases of sigmoid, 11 of carotid cavernous, 3 of petrosal apex, and 3 of sigmoid DAVF were observed. There were 12 shunt points (22 %) localized on membranous bone; in this group, there were nine cases of transverse sinus, two of superior sagittal sinus, and one case of confluence DAVF. There were ten shunt points (18 %) independent from these two bony structures: four cases of olfactory groove, four . of middle fossa, and two of hypoglossal canal DAVF. CONCLUSIONS There were correlations between the localization of shunt points of DAVFs and the topography of endochondral bone and the membranous bone. The histological difference of endochondral bone and membranous bone at the level of epidural space might cause the formation of DAVFs.
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Luo CB, Chang FC, Teng MMH, Ting TW. Anatomic Variation of Facial Vein in Carotid-Cavernous Fistula and Trans–Facial Vein Embolization. World Neurosurg 2015; 84:90-6. [DOI: 10.1016/j.wneu.2015.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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Ashour R, Chavali R. Neuromeningeal access for transarterial intravenous carotid-cavernous fistula embolization. Interv Neuroradiol 2015; 21:234-9. [PMID: 25943849 DOI: 10.1177/1591019915581968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
While numerous endovascular access routes have been described for carotid-cavernous fistula (CCF) treatment, transarterial embolization via the neuromeningeal trunk of the ascending pharyngeal artery is typically avoided due to the risk of cranial nerve palsy or non-target embolization via external-to-internal carotid anastamoses. We present the case of a dural CCF in which access to the venous side of the fistula was achieved via the neuromeningeal trunk and allowed for curative transarterial intravenous coil/liquid embolic embolization of the lesion. The utility of a transarterial intravenous approach in the face of venous sinus occlusion is highlighted. The neuromeningeal trunk should not be overlooked as a potential access route for transarterial intravenous CCF embolization in cases where traditional endovascular access is limited; this approach does not carry the same risks that are generally associated with pure transarterial embolization along this pathway.
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Affiliation(s)
- Ramsey Ashour
- Departments of Neurosurgery and Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA
| | - Ram Chavali
- Departments of Neurosurgery and Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA
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Rodrigues T, Willinsky R, Agid R, TerBrugge K, Krings T. Management of dural carotid cavernous fistulas: a single-centre experience. Eur Radiol 2014; 24:3051-8. [DOI: 10.1007/s00330-014-3339-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 06/24/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Rammos S, Bortolotti C, Lanzino G. Endovascular Management of Intracranial Dural Arteriovenous Fistulae. Neurosurg Clin N Am 2014; 25:539-49. [DOI: 10.1016/j.nec.2014.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhao WY, Krings T, Yang PF, Liu JM, Xu Y, Li Q, Fang YB, Huang QH, Wu YF. Balloon-assisted superselective microcatheterization for transarterial treatment of cranial dural arteriovenous fistulas: technique and results. Neurosurgery 2013; 71:ons269-73; discussion ons273. [PMID: 22791037 DOI: 10.1227/neu.0b013e3182684b70] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In transarterial embolization of anterior cranial fossa and tentorial dural arteriovenous fistula (DAVF), acute angulation of the feeding artery off the internal carotid artery (ICA) may render stable distal catheterization and, therefore, successful transarterial treatment difficult. In some anatomic dispositions, following selection of the feeding artery, subsequent forward force may lead to prolapse of the microcatheter into the ICA rather than advancing it into either the ophthalmic artery or the meningohypophyseal trunk. OBJECTIVE We describe a technique that facilitates stable positioning of the microcatheter by using a nondetachable balloon to temporally block the ICA distal to the feeding artery to redirect the catheter into the feeder and to prevent the microcatheter from protruding into the parent artery. METHODS In 8 cases where routine superselective microcatheterization failed, a balloon was used to block the ICA distal to the feeding artery in an attempt to facilitate superselective microcatheterization. The balloon was inflated following selection of the feeding vessel with the microcatheter and was kept inflated while advancing the catheter. RESULTS : Distal stable microcatheter positions could be obtained in all cases, which enabled us to treat the respective DAVFs with a liquid embolic agent. All 8 cases were angiographically cured with penetration of the liquid embolic agent from the distal artery to the proximal vein, and no procedure-related complications occurred. CONCLUSION The described technique may be a helpful adjunct to gain stable distal microcatheter positions during the transarterial treatment of DAVF.
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Affiliation(s)
- Wen-Yuan Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China
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Alaraj A, Kim B, Oh G, Aletich V. Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula. J Neurointerv Surg 2013; 6:e30. [DOI: 10.1136/neurintsurg-2013-010704.rep] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alaraj A, Kim B, Oh G, Aletich V. Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula. BMJ Case Rep 2013; 2013:bcr-2013-010704. [PMID: 23761619 DOI: 10.1136/bcr-2013-010704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of an elderly patient who presented with right-sided ophthalmoplegia, proptosis, chemosis, and increased intraocular pressure. An angiogram showed feeding vessels from the bilateral internal and external carotid arteries. Our initial attempt to blindly probe the inferior petrosal sinus was unsuccessful. This was followed by a right anterior orbitotomy exposing the superior ophthalmic vein which was directly cannulated with an 18 gauge angiocatheter. However, a proximal third of the superior ophthalmic vein within the orbit which was thrombosed was probed blindly. The thrombosed vein was cannulated with a microcatheter to obtain coil embolization of the carotid cavernous fistula. The implications of the procedure are discussed, given that, to our knowledge, such an endeavor has never been performed.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Cruz JP, van Dijk R, Krings T, Agid R. Ophthalmic vein compression for selected benign low-flow cavernous sinus dural arteriovenous fistulas. J Neurosurg 2013; 119:239-42. [PMID: 23540263 DOI: 10.3171/2013.2.jns121976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are acquired arteriovenous shunts between the dural branches of the internal and external carotid arteries and the cavernous sinus. These fistulas may present with cortical venous reflux, but more commonly drain antegradely toward the superior ophthalmic vein (SOV). Transvenous embolization is the most common endovascular treatment, but in some cases transvenous access to the compartment of the shunt may not be possible. In cases with no corticovenous reflux, manual compression of the SOV is an excellent alternative treatment, which is well known but rarely reported in the literature. The authors describe a series of 3 cavernous DAVFs with anterior drainage treated successfully by intermittent manual compression of the SOV.
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Affiliation(s)
- Juan Pablo Cruz
- Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Kojima A, Onozuka S, Kinoshita Y. Resolution of clinical symptoms after reopening of an occluded inferior petrosal sinus in a patient with a cavernous sinus dural arteriovenous fistula. A case report. Interv Neuroradiol 2013; 19:78-82. [PMID: 23472728 DOI: 10.1177/159101991301900112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/01/2012] [Indexed: 11/17/2022] Open
Abstract
We describe a rare case with a cavernous sinus (CS) dural arteriovenous fistula (DAVF) in which the clinical symptoms disappeared after the patient underwent reopening of an occluded inferior petrosal sinus (IPS). A 66-year-old woman presented with increased intraocular pressure, chemosis, and proptosis on the left side. Angiography demonstrated a left CS DAVF supplied by the dural branches of bilateral internal carotid arteries. The shunt flow was directed to the superior and inferior ophthalmic veins, while the bilateral IPSs were not opacified. Accordingly, a transvenous embolization of the fistula was attempted. Although the microcatheter was navigated to the cavernous sinus through the occluded left IPS, obliteration of the fistula was unsuccessful because of the failure of superselective catheterization at the fistulous point. However, the final image demonstrated the development of an antegrade shunt flow through the left IPS to the internal jugular vein and disappearance of the retrograde reflux to the superior and inferior ophthalmic veins. The patient's clinical symptoms immediately resolved after the operation, and the symptoms have not recurred during a one-year follow-up period. Inappropriate transvenous embolization of CS DAVFs can result in vascular complications arising from the unintentional redistribution of shunt flow. The present case illustrates that the disappearance of retrograde shunt flow to the ophthalmic veins after reopening of the occluded IPS may be sufficient if a superselective approach fails or is anticipated to result only in an incomplete embolization of the fistulous point.
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Affiliation(s)
- A Kojima
- Department of Neurosurgery, Saitama City Hospital, Saitama, Japan.
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