E-030 Transvenous Microguidewire Looping Technique for Breach of Ipsilateral Inferior Petrosal Sinus Occlusions En Route to Cavernous Sinus Dural Arteriovenous Fistulas

Background and purpose Angioplasty of the dural sinus has rarely been performed for the treatment of cavernous sinus dural arteriovenous fistulas. We evaluated the efficacy of selective transvenous embolization (TVE) combined with balloon angioplasty of the occluded inferior petrosal sinus (IPS) for the treatment of cavernous sinus dural arteriovenous fistulas (CSDAVFs). Materials and methods A total of 8 consecutive patients with CSDAVFs with occlusion of the IPS treated by selective TVE with balloon angioplasty of the IPS from July 2018 to January 2019 were retrospectively reviewed. There were 6 females and 2 males with an average age of 77.6 years. All patients showed ocular symptoms. Angiography showed cortical venous reflux in 7 cases and localized shunted pouches at the medial portion of the cavernous sinus, intercavernous sinus, or laterocavernous sinus. Selective TVE was performed via the occluded IPS with bilateral femoral venous approaches, and the occluded IPS was reconstructed by angioplasty with a 2- to 3-mm diameter balloon during or after selective TVE. Results CSDAVFs disappeared immediately after treatment, and the occluded IPSs were successfully reconstructed with re-establishment of normal antegrade venous flow in all cases. No complications were observed, and symptoms resolved within 2 weeks after treatment. During the 7-month mean follow-up period (range 1-12 months), no cases showed recurrence of CSDAVFs. Conclusion Selective TVE combined with balloon angioplasty of the occluded IPS is safe and effective for the treatment of CSDAVFs and re-establishes normal venous circulation in selected cases with localized shunted pouches.

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Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach

European Radiology ◽

10.1007/s00330-010-1857-9 ◽

2010 ◽

Vol 20 (12) ◽

pp. 2939-2947 ◽

Cited By ~ 5

Author(s):

Zheng-Ran Li ◽

Zai-Bo Jiang ◽

Ming-Sheng Huang ◽

Kang-Shun Zhu ◽

Qing Wang ◽

...

Keyword(s):

Cavernous Sinus ◽

Inferior Petrosal Sinus ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Detachable Coils ◽

Glubran 2 ◽

Acrylic Glue

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The Angle of the Microguidwire on the Lateral Projection: a Prediction of Cannulation of the Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas

10.21203/rs.3.rs-707075/v1 ◽

2021 ◽

Author(s):

Xianli Lv

Keyword(s):

Internal Jugular Vein ◽

Cavernous Sinus ◽

Jugular Vein ◽

Inferior Petrosal Sinus ◽

Transvenous Embolization ◽

Lateral Projection ◽

Arteriovenous Fistulas ◽

Fluoroscopic Image ◽

Dural Arteriovenous Fistulas ◽

Transvenous Approach

Abstract OBJECTIVE: To describe that the angle of the guidwire on lateral projection under fluoroscopic image is a prediction of cannulation of the occluded inferior petrosal sinus in the transvenous embolization of cavernous sinus dural fistulas.METHODS: From January 2018 through January 2021, 12 consecutive cavernous sinus dural fistulas with ipsilateral inferior petrosal sinus occlusion identified in 12 patients were cured by cannulation of the occluded ipsilateral inferior petrosal sinus. Clinical, radiologic and procedure data of the 12 patients were retrospectively reviewed. The angle of microguidewire between on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was measured by 180°Protractor(Deli Group Co., LTD, Zhejiang, China). RESULTS: In the 12 patients, access via the occluded ipsilateral inferior petrosal sinus was primarily attempted as the transvenous approach. During the procedure, the angle of microguidwire on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was 117°±7°, which is very useful to confirm the cannulation of the occluded inferior petrosal sinus. Complete occlusion was achieved in all fistulas, with no procedure-related morbidity or mortality. Postprocedural symptom was improved in all patients. CONCLUSION: Cannulation of an occluded inferior petrosal sinus is possible and reasonable as an initial access attempt for cavernous sinus dural fistulas. The angle of microguidwire on the lateral projection under fluoroscopic image can help to confirm the orifice of the occluded inferior petrosal sinus.

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Transvenous microguidewire looping technique for breach of ipsilateral inferior petrosal sinus occlusions en route to cavernous sinus dural arteriovenous fistulas

Interventional Neuroradiology ◽

10.1177/1591019916653251 ◽

2016 ◽

Vol 22 (5) ◽

pp. 590-595 ◽

Cited By ~ 10

Author(s):

Young Dae Cho ◽

Jong Kook Rhim ◽

Dong Hyun Yoo ◽

Hyun-Seung Kang ◽

Jeong Eun Kim ◽

...

Keyword(s):

Cavernous Sinus ◽

Coil Embolization ◽

Inferior Petrosal Sinus ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Embolic Materials ◽

Transvenous Approach ◽

Cure Rates ◽

Guiding Catheter

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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Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

Journal of Neurosurgery ◽

10.3171/2010.8.gks10977 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 21-27 ◽

Cited By ~ 5

Author(s):

Hyun Ho Jung ◽

Jong Hee Chang ◽

Kum Whang ◽

Jin Soo Pyen ◽

Jin Woo Chang ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Transarterial Embolization ◽

Gamma Knife Surgery ◽

Low Flow ◽

Close Monitoring ◽

Arteriovenous Fistulas ◽

Ocular Symptoms ◽

Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

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Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.ra.2020-0042 ◽

2020 ◽

Vol 14 (12) ◽

pp. 593-604

Author(s):

Masafumi Hiramatsu ◽

Kenji Sugiu ◽

Jun Haruma ◽

Tomohito Hishikawa ◽

Yu Takahashi ◽

...

Keyword(s):

Cavernous Sinus ◽

Arteriovenous Fistulas ◽

Parasellar Region ◽

Dural Arteriovenous Fistulas

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Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

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