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

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.

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.

scholarly journals Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

2021 ◽  
Author(s):  
Rajendra Chavan ◽  
Shreya Sethi ◽  
Harsha Sahu ◽  
Neeraj Rao ◽  
Shivani Agarwal
Keyword(s):  
Literature Review ◽  
Treatment Option ◽  
Systematic Literature Review ◽  
Superior Sagittal Sinus ◽  
English Literature ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Special Subgroup

AbstractDural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

The Natural History of Cerebral Dural Arteriovenous Fistulae

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 594-603 ◽  
Author(s):  
Bradley A. Gross ◽  
Rose Du
Keyword(s):  
Natural History ◽  
Significant Risk ◽  
Venous Drainage ◽  
Type I ◽  
Type Ii ◽  
Arteriovenous Fistulae ◽  
Type Iii ◽  
History Of ◽  
Venous Ectasia ◽  
Cortical Venous Drainage

Abstract BACKGROUND: Hemorrhage from cerebral dural arteriovenous fistulae (dAVF) is a considerable source of neurological morbidity and even mortality. OBJECTIVE: To evaluate the natural history of cerebral dAVF. METHODS: We reviewed our own cohort of 70 dAVF and incorporated results from the literature, synthesizing pooled hemorrhage rates and evaluating risk factors for 395 dAVF in 6 studies. RESULTS: No hemorrhages occurred during 409 lesion-years of follow-up of Borden type I dAVF; however, cortical venous drainage developed in 1.4%. Like type I dAVF, type II dAVF demonstrated a female predilection and were most commonly transverse-sigmoid or cavernous. Eighteen percent of type II dAVF presented with hemorrhage (95% confidence interval [CI]: 8%-36%), and the annual hemorrhage rate was 6% (95% CI: 0.1%-19%). Borden type III dAVF demonstrated a male predilection and were most commonly tentorial or petrosal. Thirty-four percent presented with hemorrhage (95% CI: 0.4%-49%), with an annual hemorrhage rate of 10% (95% CI: 4%-20%), increasing to 21% for those with venous ectasia (95% CI: 4%-66%). The hemorrhage rate decreased to 2% for asymptomatic or minimally symptomatic type II or III dAVF (95% CI: 0.2%-8%), and increased to 10% for those presenting with nonhemorrhagic neurological deficits (95% CI: 0.9%-41%) and to 46% for those presenting with hemorrhage (95% CI: 11%-130%). CONCLUSION: Venous ectasia is a significant risk factor for hemorrhage among dAVF with cortical venous drainage. In addition, those with hemorrhagic presentation, even compared with nonhemorrhagic neurological deficit presentation, as well as Borden type III dAVF compared with type II dAVF demonstrated a trend toward greater hemorrhage rates.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

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