DSA-Dynavision in pretreatment planning for coil embolization of indirect carotid–cavernous fistula

2016 ◽  
Vol 9 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Alex Botsford ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Coil Embolization ◽  
Neurological Complication ◽  
Case Series ◽  
Procedure Time ◽  
Venous Reflux ◽  
Carotid Cavernous Fistula ◽  
Procedural Time ◽  
Cortical Venous Reflux ◽  
Procedural Planning ◽  
Carotid Cavernous Fistulas

IntroductionIndirect carotid cavernous fistulas are treated with coil embolization when they present with orbital/visual symptoms or if there is cortical venous reflux. Most of the time, the treatment is done by non-specifically packing the whole cavernous sinus with coils. The purpose of this case series was to examine whether DSA-Dynavision before embolization would improve treatment by shortening the procedure time, requiring fewer coils, or reducing the complication rate.Materials and method8 patients with 9 fistula sites were retrospectively identified. DSA-Dynavision and non-DSA-Dynavision patients were compared in a retrospective cohort study.ResultsMean total coil length was significantly shorter for the group who had DSA-Dynavision than for those who had non-DSA-Dynavision (130.5 cm vs 190 cm, p=0.034) and mean procedural time was significantly shorter for the DSA-Dynavision group (171.1 min vs 280.3 min, p=0.025). A transient neurological complication was seen in only one patient.ConclusionsThe use of DSA-Dynavision in pre-procedural planning facilitates selective coil embolization of the foot of the vein.

scholarly journals Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 167-173 ◽  
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
T. Otani ◽  
K. Yasuda ◽  
N. Tomura ◽  
...  
Keyword(s):  
Signal Intensity ◽  
Venous Drainage ◽  
Brain Parenchyma ◽  
Venous Congestion ◽  
Venous Reflux ◽  
Carotid Cavernous Fistula ◽  
Abnormal Signal ◽  
Cortical Venous Reflux ◽  
Abnormal Signal Intensity ◽  
The Brain

Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma. We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux. CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and results in venous congestion of the brain parenchyma or intracerebral haemorrhage. Hyperintensity of brain parenchyma along the region of cortical venous reflux on T2-weighted images reflects venous congestion and is the crucial finding that indicates concentration of venous drainage into cortical venous reflux.

Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux

1995 ◽  
Vol 8 (6) ◽  
pp. 167-173
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
T. Otani ◽  
K. Yasuda ◽  
N. Tomura ◽  
...  
Keyword(s):  
Signal Intensity ◽  
Venous Drainage ◽  
Brain Parenchyma ◽  
Venous Congestion ◽  
Venous Reflux ◽  
Carotid Cavernous Fistula ◽  
Abnormal Signal ◽  
Cortical Venous Reflux ◽  
Abnormal Signal Intensity ◽  
The Brain

Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma. We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux. CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and results in venous congestion of the brain parenchyma or intracerebral haemorrhage. Hyperintensity of brain parenchyma along the region of cortical venous reflux on T2-weighted images reflects venous congestion and is the crucial finding that indicates concentration of venous drainage into cortical venous reflux.

Thrombosis of venous outflows of the cavernous sinus: possible aetiology of the cortical venous reflux in case of indirect carotid-cavernous fistulas

2017 ◽  
Vol 159 (5) ◽  
pp. 835-843 ◽  
Author(s):  
Thomas Robert ◽  
Philippe Sylvestre ◽  
Raphaël Blanc ◽  
Daniele Botta ◽  
Gabriele Ciccio ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Reflux ◽  
Cortical Venous Reflux ◽  
Carotid Cavernous Fistulas

scholarly journals Direct carotid-cavernous fistulas occurring during neurointerventional procedures

2015 ◽  
Vol 22 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Kenichiro Ono ◽  
Hidenori Oishi ◽  
Shunsuke Tanoue ◽  
Hiroshi Hasegawa ◽  
Kensaku Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Additional Treatment ◽  
Carotid Cavernous Fistula ◽  
Anterior Circulation ◽  
Cavernous Fistula ◽  
Carotid Cavernous Fistulas ◽  
Procedure Type ◽  
Neurointerventional Procedures

This study shows the frequency and types of carotid-cavernous fistula (CCF) complications that occurred during endovascular treatment. Transarterial endovascular surgeries involving the anterior circulation were performed for 1071 cases at our hospitals during four years. CCFs occurred in nine of 1071 cases (0.8%). CCF risk factors were female sex ( p = 0.032), aneurysmal location in the paraclinoid portion ( p < 0.001), and use of a distal access catheter (DAC) ( p < 0.001). There were no significant correlations between CCF risk and procedure type ( p = 0.411–1.0) and balloon use or nonuse ( p = 0.492). Eighty-nine percent (eight of nine) of the CCFs occurred at the genu of a cavernous internal carotid artery (ICA). Two cases of CCF disappeared spontaneously. The shunt was decreased by balloon expansion in one case, no additional treatment was required in one case, and five cases required transarterial fistula coil embolization. It is necessary to remember that a CCF may occur especially in aneurysmal treatment using a DAC in a female patient. The DAC and the 0.035-inch guidewire should be kept proximal to the carotid siphon and not go beyond it. When we cannot avoid navigating beyond it, we should consider using a softer DAC. In the case of a CCF caused by a DAC, it may be cured spontaneously or is treatable by transarterial coil embolization.

scholarly journals Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

2021 ◽  
Author(s):  
Lívio Pereira de Macêdo ◽  
Arlindo Ugulino Netto ◽  
Kauê Franke ◽  
Pierre Vansant Oliveira Eugenio ◽  
John Anderson da Silva Rocha ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Neurological Complication ◽  
Case Series ◽  
Neurological Deficits ◽  
Time Interval ◽  
Automobile Accidents ◽  
Decompressive Hemicraniectomy ◽  
Cerebral Herniation ◽  
Intraoperative Period ◽  
The Brain

Abstract Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP). Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included. Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period. Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas

1974 ◽  
Vol 41 (6) ◽  
pp. 657-670 ◽  
Author(s):  
Sean Mullan
Keyword(s):  
Blood Flow ◽  
Intracranial Aneurysm ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Blood Flow ◽  
Giant Intracranial Aneurysm ◽  
Surgical Methods ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ The results of 61 cases of stereotaxic thrombosis of intracranial berry aneurysms indicate that the technique in selected cases is comparable to, but not necessarily superior to standard surgical methods. The results of wire-induced thrombosis in 15 cases of giant intracranial aneurysm suggest that this method is effective in situations where clipping and encapsulation are inapplicable. The results of thrombosis in six cases of carotid cavernous fistula suggest that intracavernous wire thrombosis may prove to be the treatment of choice in that it seals the fistula without impairing carotid blood flow.

Deflation of metrizamide-filled balloon used to occlude a carotid-cavernous fistula

1983 ◽  
Vol 59 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Thomas J. Leipzig ◽  
Sean F. Mullan
Keyword(s):  
Contrast Agent ◽  
Vascular Wall ◽  
Carotid Cavernous Fistula ◽  
Technical Problems ◽  
Content Type ◽  
Cavernous Fistula ◽  
Short Summary ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.

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