Bilateral orbital signs predict cortical venous drainage in cavernous sinus dural AVMs. Steibel-Kalish H,∗∗Neuro-ophthalmology Service, Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel. E-mail: [email protected] Setton A, Berenstein A, Kalish Y, Nimii Y, Kupersmith MJ. Neurology 2002;58:1521-1524.

2002 ◽  
Vol 134 (4) ◽  
pp. 641-642
Author(s):  
Hans E Grossniklaus
Keyword(s):  
Cavernous Sinus ◽  
Medical Center ◽  
Venous Drainage ◽  
Department Of Ophthalmology ◽  
Service Department ◽  
Cortical Venous Drainage ◽  
E Mail ◽  
Rabin Medical

A new transvenous approach to the carotid-cavernous sinus via the inferior petrooccipital vein

2012 ◽  
Vol 116 (3) ◽  
pp. 581-587 ◽  
Author(s):  
Akira Kurata ◽  
Sachio Suzuki ◽  
Kazuhisa Iwamoto ◽  
Kuniaki Nakahara ◽  
Madoka Inukai ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Inferior Petrosal Sinus ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cushing Disease ◽  
Cortical Vein ◽  
The Third ◽  
Cortical Venous Drainage ◽  
Transvenous Approach

Object The transvenous approach via the inferior petrosal sinus (IPS) is commonly used as the most appropriate for carotid-cavernous fistula (CCF) or cavernous sinus sampling. However, sometimes the IPS is not accessible because of anatomical problems and/or complications, therefore an alternative route is needed. In this paper, the authors present and discuss the utility of a transvenous approach to the cavernous sinus via the inferior petrooccipital vein. Methods Four patients, 3 with dural CCFs and the other with Cushing disease, in whom endovascular surgical attempts failed using a conventional venous approach via the IPS, underwent a transvenous approach to the cavernous sinus via the inferior petrooccipital vein (IPOV). One dural CCF case had only cortical venous drainage, the second CCF also mainly drained into the cortical vein with slight inflow into the superior ophthalmic vein and inferior ophthalmic vein, and the third demonstrated drainage into the superior and inferior ophthalmic veins and IPOV. Results In all cases, the cavernous sinus could be accessed successfully via this route and without complications. Conclusions The transvenous approach to the cavernous sinus via the IPOV should be considered as an alternative in cases when use of the IPS is precluded by an anatomical problem and there are no other suitable venous approach routes.

scholarly journals Puncture of the Superficial Sylvian Vein for Embolisation of Cavernous Dural Arteriovenous Fistula

1999 ◽  
Vol 5 (2) ◽  
pp. 167-170 ◽  
Author(s):  
G. Benndorf ◽  
T.N. Lehmann ◽  
H.P. Molsen ◽  
W. Lanksch ◽  
R. Felix
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Direct Puncture ◽  
Arteriovenous Fistulas ◽  
Surgical Exposure ◽  
Dural Arteriovenous Fistulas ◽  
Femoral Route ◽  
Endovascular Approach ◽  
Catheter Navigation ◽  
Cortical Venous Drainage

Dural arteriovenous fistulas (DAVF's) of the cavernous sinus are curable by endovascular means in the vast majority of cases. Both transarterial and transvenous approaches by femoral route can be used for closure. In rare cases with unsuitable anatomy or angioarchitecture, an endovascular approach is proposed by open surgical exposure of a major venous outflow, e.g. the superior ophthalmic vein. We report on a case of unsuccessful attempts at transarterial and transvenous catheter navigation through traditional endovascular routes, where surgical exposure of the major cortical venous drainage was necessary. A direct puncture of the sylvian vein allowed placement of a microcatheter in the cavernous sinus and occlusion of the fistula by coils.

Bilateral orbital signs predict cortical venous drainage in cavernous sinus dural AVMs

Neurology ◽  
2002 ◽  
Vol 58 (10) ◽  
pp. 1521-1524 ◽  
Author(s):  
H. Stiebel-Kalish ◽  
A. Setton ◽  
A. Berenstein ◽  
Y. Kalish ◽  
Y. Nimii ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Cortical Venous Drainage

Transvenous Embolisation of Spontaneous Carotid-Cavernous Fistulas by Sequential Occlusion of the Cavernous Sinus

1999 ◽  
Vol 5 (3) ◽  
pp. 225-234 ◽  
Author(s):  
K.-M. Cheng ◽  
C.-M. Chan ◽  
Y.-L. Cheung ◽  
C.-C. Liang ◽  
M.-K. Lee ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Clinical Cure ◽  
Venous Drainage ◽  
Clinical Results ◽  
Late Complications ◽  
Pathological Features ◽  
Cortical Venous Drainage ◽  
The Right ◽  
Carotid Cavernous Fistulas

There are two important pathological features associated with carotid-cavernous fistula (CCF): the retrograde cortical venous drainage that can cause intracranial haemorrhage and non haemorrhagic neurological deficit and the retrograde ophthalmic venous drainage that causes orbital venous congestion and visual impairment. We propose a sequential embolisation strategy by the selective occlusion of these two pathological features as the initial steps followed by occlusion of the rest of the cavernous sinus. Eight patients with spontaneous CCF were treated by transvenous embolisation using our embolisation strategy. The clinical features, angiographic findings, embolisation procedures, and clinical and angiographic outcomes were analyzed. The follow-up period ranged from one to 21 months. Clinical cure was achieved in six patients at one to two month follow-ups. One patient with bilateral CCFs had clinical cure of the right eye and clinical improvement of the left eye at three-month follow-up. Another patient had clinical cure at one-month follow-up except residual VI nerve palsy. Two patients had complete angiographic obliteration of the fistula immediately after the embolisation procedure. Another three patients underwent follow-up angiography at one to 16 months and all showed angiographic cure. There were no immediate or late complications. Our embolisation strategy offers a safe and effective option in the embolisation of spontaneous CCF as demonstrated by the clinical results of our eight patients.

Parallel Venous Channel as the Recipient Pouch in Transverse/Sigmoid Sinus Dural Fistulae

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1261-1267 ◽  
Author(s):  
Louis P. Caragine ◽  
Van V. Halbach ◽  
Chris F. Dowd ◽  
Perry P. Ng ◽  
Randall T. Higashida
Keyword(s):  
San Francisco ◽  
Medical Center ◽  
Venous Drainage ◽  
Sigmoid Sinus ◽  
Common Location ◽  
Arterial Inflow ◽  
Cortical Venous Drainage ◽  
Ablative Procedures ◽  
The University

Abstract OBJECTIVE The most common location for dural arteriovenous fistulae (AVFs) is the transverse/sigmoid sinus. We describe our prospective analysis of data for 10 patients with recipient fistulae parallel to the transverse/sigmoid sinus. Recognition of this entity allows embolization of the fistula with preservation of the parent sinus. This report reviews the presentation and angiographic characteristics of the “parallel venous channel” and the treatment results for this series of patients. METHODS Between 1995 and June 2002, at the medical center of the University of California, San Francisco, we identified 10 patients with a parallel venous channel as the recipient pouch for all arterial input into a transverse/sigmoid sinus AVF. The clinical presentations, angiographic features, endovascular treatments, and outcomes are described. Angiographic follow-up monitoring was performed for 1 to 6 years for all patients with cortical venous drainage (5 of 10 patients). Clinical follow-up periods ranged from 1 to 7 years. RESULTS All patients presented with pulsatile tinnitus disruptive to sleep. Other symptoms included severe headaches, papilledema and visual disturbances, hemiparesis, and mastoid pain. All 10 parallel venous channels communicated with the transverse or sigmoid sinus. Cortical venous drainage was present in 50% of cases. Endovascular ablative procedures, using either coils or ethanol, were performed for all patients. The parallel venous channel was successfully embolized, with preservation of the transverse/sigmoid sinus, for all 10 patients. There were no major complications. All patients experienced resolution of their symptoms, with no recurrence. CONCLUSION The existence of a parallel venous channel as the recipient pouch for all arterial inflow in a series of 10 transverse/sigmoid sinus AVFs is described. Endovascular obliteration of the parallel channel, with preservation of the parent sinus, was successfully performed for all 10 patients. Recognition of the parallel venous channel is clinically important for the treatment of transverse/sigmoid AVFs.

TRANSARTERIAL EMBOLIZATION OF CLIVAL DURAL ARTERIOVENOUS FISTULAE USING LIQUID EMBOLIC AGENTS

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 408-415 ◽  
Author(s):  
Zhong-Song Shi ◽  
Jordan Ziegler ◽  
Nestor R. Gonzalez ◽  
Lei Feng ◽  
Satoshi Tateshima ◽  
...  
Keyword(s):  
Los Angeles ◽  
Cavernous Sinus ◽  
Medical Center ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Ocular Symptoms ◽  
Embolic Agents ◽  
Liquid Embolic

Abstract OBJECTIVE Dural arteriovenous fistulae (DAVFs) rarely involve the clivus. This report examines the clinical presentation, angiographic findings, endovascular management, and outcome of clival DAVFs. Particular attention was given to safety and efficacy of transarterial embolization using liquid embolic agents. METHODS We reviewed the clinical and radiological data of 10 patients with spontaneous clival DAVFs who were treated endovascularly at the University of California at Los Angeles Medical Center between 1992 and 2006. RESULTS Nine patients presented with ocular symptoms and one patient experienced pulsatile tinnitus. Cerebral angiograms showed that these clival DAVFs were supplied by multiple branches of the internal and external carotid arteries. The patterns of venous drainage were from the clival veins to the cavernous sinus and superior ophthalmic vein in nine patients and to the inferior petrosal sinus in two patients. Six clival DAVFs were embolized transarterially through the clival branches of the ascending pharyngeal artery. Onyx 18 (Micro Therapeutics Inc., Irvine, CA) was used in three patients and n-butyl cyanoacrylate was used in three patients. Immediate complete angiographic obliteration was achieved in three patients. All six patients experienced an angiographic and clinical cure without any complications at 3 months. Two patients were incompletely treated using particles and coils for the relief of the symptoms. Two other patients were completely treated after the recipient clival venous structures were occluded transvenously with coils. CONCLUSION Clival DAVFs can be misdiagnosed as dural cavernous sinus fistulae. The best treatment is transarterial embolization of the dural feeders using liquid embolic agents. Transvenous occlusion of the cavernous sinus is unnecessary in most cases.

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