E-092 Endovascular treatment of bilateral cavernous sinus dural arteriovenous fistula: therapeutic strategy and follow-up outcome

A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.The video can be found here: http://youtu.be/u_4Oc7tSmDM.

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Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas

Interventional Neuroradiology ◽

10.1177/1591019915582925 ◽

2015 ◽

Vol 21 (3) ◽

pp. 357-361 ◽

Cited By ~ 6

Author(s):

Ming Lv ◽

Chuhan Jiang ◽

Dong Liu ◽

Zhiguang Ning ◽

Jun Yang ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Three Dimensional ◽

Fluoroscopic Guidance ◽

Superior Orbital Fissure ◽

Arteriovenous Fistulas ◽

Skull Reconstruction ◽

Dural Arteriovenous Fistulas

Objective To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. Methods One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. Results Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. Conclusion Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.

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Evaluation for shunted pouches of cavernous sinus dural arteriovenous fistula and the treatment outcome of transvenous embolization

Interventional Neuroradiology ◽

10.1177/1591019917743064 ◽

2017 ◽

Vol 24 (2) ◽

pp. 189-196 ◽

Cited By ~ 3

Author(s):

Masaki Sato ◽

Takashi Izumi ◽

Noriaki Matsubara ◽

Masahiro Nishihori ◽

Shigeru Miyachi ◽

...

Keyword(s):

Treatment Outcome ◽

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Three Dimensional ◽

Transvenous Embolization ◽

Posterior Compartment ◽

Selective Embolization ◽

Complete Occlusion

Background This study aimed to evaluate the detailed location and the number (single or multiple) of cavernous sinus dural arteriovenous fistula (CSDAVF) shunted pouches as well as the relationship between the characteristics of shunted pouch(es) and the treatment outcome of transvenous embolization for CSDAVF. Methods A total of 23 consecutive patients with CSDAVFs who underwent angiogram and transvenous embolization were retrospectively analyzed. Shunted pouches were assessed using three-dimensional angiogram and multiplanar reformatted image obtained from the rotational angiogram data. Results Of the 23 patients with CSDAVFs, 40 shunted pouches were identified. Twelve CSDAVFs had a single shunted pouch, and 11 had multiple shunted pouches. The mean CSDAVF with multiple shunted pouches was 2.5. The shunted pouches were more often found in the posterior compartment of the CS, which was connected with the intercavernous sinus (23/40; 57.5%). In 12 CSDAVFs with a single shunted pouch, 10 were treated with selective embolization and complete occlusion was achieved during the follow-up. Two CSDAVFs with single shunted pouch were just observed without intervention, and DAVFs disappeared spontaneously during the follow-up period. In 11 CSDAVFs with multiple shunted pouches, eight were treated with selective embolization and three with sinus embolization. In six of eight (75%), complete occlusion was achieved following selective embolization, but two of eight (25%) recurred and required retreatment. Conclusions Rotational angiography data suggested that the shunted pouches of CSDAVFs were mostly located in the posterior compartment of the CS connected with the intercavernous sinus. Selective embolization for CSDAVFs with a single shunted pouch is the first-line treatment alternative to sinus packing, and selective embolization with multiple shunted pouches will be a considerable treatment option.

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Surgical cannulation of a cortical draining vein for endovascular treatment of a dural arteriovenous fistula of the cavernous sinus

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.08.011 ◽

2011 ◽

Vol 18 (4) ◽

pp. 576-578 ◽

Cited By ~ 7

Author(s):

Jonathan G. Thomas ◽

Joshua J. Chern ◽

Michel E. Mawad ◽

Edward A.M. Duckworth

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Surgical Cannulation

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Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula With Ipsilateral Inferior Petrosal Sinus Occlusion

Neurosurgery ◽

10.1227/neu.0000000000000751 ◽

2015 ◽

Vol 77 (2) ◽

pp. 192-199 ◽

Cited By ~ 19

Author(s):

Jong Kook Rhim ◽

Young Dae Cho ◽

Jeong Jin Park ◽

Jin Pyeong Jeon ◽

Hyun-Seung Kang ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Treatment Strategies ◽

Symptom Improvement ◽

Inferior Petrosal Sinus ◽

Paradoxical Worsening ◽

Transvenous Approach ◽

Arterial Feeder

Abstract BACKGROUND: Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus. OBJECTIVE: To describe our experience with endovascular treatment of CSdAVF complicated by ipsilateral IPS occlusion. METHODS: From January 2003 through September 2014, a total of 49 CSdAVFs with ipsilateral IPS occlusion were identified in 49 patients, who then underwent endovascular treatment. Clinical and radiologic data were retrospectively reviewed. RESULTS: Either transvenous (n = 38) or transarterial (n = 11) access was initially elected, the latter reserved for single-hole or dominant arterial feeder fistulas. Access via occluded ipsilateral IPS was usually attempted (n = 34) by transvenous approach, with a 54.3% success rate. Anterior (n = 3) or posterior (n = 1) facial vein was alternatively used. Direct surgical exposure of ophthalmic vein (n = 3) or radiosurgery (n = 4) was performed for access failure or unsuccessful occlusion by other means. In 46 fistulas (93.9%), complete occlusion was achieved, with no procedure-related morbidity or mortality. Postprocedural symptom improvement was noted in all but 2 patients, who separately experienced paradoxical worsening of cranial nerve palsy and access failure. CONCLUSION: In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.

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Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein

Neuroradiology ◽

10.1007/s00234-003-1020-2 ◽

2003 ◽

Vol 45 (8) ◽

pp. 574-578 ◽

Cited By ~ 38

Author(s):

C. Venturi ◽

S. Bracco ◽

A. Cerase ◽

P. Gennari ◽

F. Lor� ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Superior Ophthalmic Vein

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Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

Neurointervention ◽

10.5469/neuroint.2021.00157 ◽

2021 ◽

Author(s):

Wen Nian Tan ◽

Arvin Rajadurai ◽

Dhayal Balakrishnan

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Radial Artery ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Conventional Technique ◽

External Carotid ◽

Transfemoral Approach ◽

Vein Access ◽

Median Cubital Vein

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.

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