A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route

Shinoda, Narihide; Mori, Masafumi; Tamura, Shogo; Korosue, Kazuyoshi; Kose, Shigeru; Imai, Hiroto; Enomoto, Tetsuya; R, Tominaga; Masahira, Toshio; Miki, Tatsuya; Hiura, Tomoya; Shimoda, Ken; Suwa, Keiichiro; Obata, Junichi; Adachi, Mutsuma; Matsumoto, Yasushi; Kohmura, Eiji

doi:10.5797/jnet.cr.2018-0069

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…With so many fistulas, this type usually produces a large flow into the cavernous sinus, causing severe clinical presentation and is difficult to treat by transarterial embolization. In order to explain the clinical symptoms and methods of intervention for this disease, venous drainage was mentioned, including posterior and/or anterior and/or cortical drainage routes [1,2,8]. In our patient case, arteriograms demonstrated the absence of cortical-pial venous reflux due to a variant of Sylvian vein drainage via the foramen ovale into the pterygopalatine venous plexus.…”

Section: Discussionmentioning

confidence: 75%

“…However, if the FV is not present, a direct puncture of the SOV or cavernous sinus (CS) has been reported [3,5,6]. Complications related to SOV puncture in the angiography suite, such as intra- orbital hemorrhage and thrombosis of SOV, have been reported, as in the present case [7,8]. However, these complications do not need management and may regress without ophthalmic problems.…”

Section: Introductionmentioning

confidence: 71%

“…The complication of thrombosis of the SOV may occur immediately after puncture and, depending on the state of a drainage route, may cause postoperative non-arteritic ischemic optic neuropathy. To avoid this complication, puncture methods and heparinization should be considered after sufficiently investigating drainage routes [8].…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Ultrasound-Guided Access to the Superior Ophthalmic Vein for Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Đức

Hoa

Huy

et al. 2020

Cureus

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The treatment of symptomatic cavernous sinus dural arteriovenous fistula, an unusually occluded cavernous sinus, is by a transvenous approach through the inferior petrosal sinus and superior ophthalmic vein. If these two modes of conventional transvenous access are not possible, surgical exposure and/or direct puncture access to the superior ophthalmic vein or cavernous sinus have been previously described. In a patient with progressive ophthalmological problems, the goal of treatment is to not only cure the ophthalmic symptoms but also to conserve or improve visual acuity, so treatment is needed as soon as possible. We report a 68year-old woman suffering a Barrow type D cavernous sinus dural arteriovenous fistula. In this case, inadequate, inferior petrosal sinus embolization and lack of access for superior ophthalmic vein via a facial vein preceded percutaneous puncture under sonographic guidance of the superior ophthalmic vein. This permitted venous occlusion without complications and symptom-free for 11 months.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 71%

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Percutaneous Ultrasound-Guided Access to the Superior Ophthalmic Vein for Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Đức

Hoa

Huy

et al. 2020

Cureus

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“…However, these complications can be minimized by safe puncture methods and adequate heparinization. 10 The 3D digital subtraction angiography method helps us for the exact identification of the fistulous point and venous drainage pathway, including draining vein stenosis in relation to bony structures of the skull base. Awareness of the complex venous drainage at the skull base is vital for treatment planning and for understanding the symptoms of ACC DAVFs.…”

Section: Discussionmentioning

confidence: 99%

Direct Superior Ophthalmic Vein Approach to Treat Anterior Condylar Confluence Dural Arteriovenous Fistula

et al. 2021

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Dural arteriovenous fistulas (DAVFs) are acquired pathological arteriovenous connections involving vessels that usually supply the meninges. A DAVF in the region of the hypoglossal canal is a rare form of fistula that involves the anterior condylar confluence or anterior condylar vein. We report a case of hypoglossal canal DAVF that was successfully embolized transvenously through a superior ophthalmic vein (SOV) approach. After failed attempts through jugular access, our patient was treated by a unique percutaneous direct puncture approach through the SOV, achieving complete obliteration of the fistula. A step-by-step description of the endovascular technique was described. The clinical course was uneventful without any new neurologic deficit. The eye symptoms and third nerve palsy had completely resolved at the 3-month follow-up visit. Hypoglossal canal DAVFs are rare and may exhibit complex venous drainage patterns. Knowledge of the complex venous anatomy is essential for planning an alternative transvenous route if the standard approach is not feasible. Xper CT (Philips Healthcare, Best, The Netherlands) is an excellent tool for identifying the exact site of the fistula as well as for confirming a safe position of the catheter tip for successful occlusion of this complex dural AV fistula.

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“…For direct puncture of the SOV, various complications, such as puncture-related intraorbital hemorrhage, injury of the levator muscle and supraorbital nerve, orbital infection, granulomas, damage to the trochlear nerve, and nonarteritic ischemic optic neuropathy, have been reported. [ 6 , 17 , 18 ] Moreover, if the SOV is occluded due to SOV injury and retrograde cortical venous drainage occurs, the CSDAVF becomes an aggressive lesion with a risk for intracranial hemorrhage. For these reasons, the transfemoral venous approach is preferred over direct puncture of the STV or the SOV.…”

Section: Discussionmentioning

confidence: 99%

Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein

Shibata

Nishikawa

Kitamura³

et al. 2021

Surgical Neurology International

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Background: Transvenous embolization through the inferior petrosal sinus (IPS) is the most common treatment procedure for cavernous sinus dural arteriovenous fistula (CSDAVF). When the IPS is inaccessible or the CSDAVF cannot be treated with transvenous embolization through the IPS, the superficial temporal vein (STV) is used as an alternative access route. However, the approach through the STV is often challenging because of its tortuous and abruptly angulated course. We report a case of recurrent CSDAVF which was successfully treated using a chronic total occlusion (CTO)-dedicated guidewire and by straightening the STV. Case Description: A 63-year-old woman was diagnosed with CSDAVF on examination for oculomotor and abducens nerve palsy. She was initially treated with transvenous embolization through the IPS. However, CSDAVF recurred, and transvenous embolization was performed through the STV. A microcatheter could not be navigated because of the highly meandering access route through the STV. By inserting a CTO-dedicated guidewire into the microcatheter, the STV was straightened and the microcatheter could be navigated into a shunted pouch of the CS. Finally, complete occlusion of the CSDAVF was achieved. Conclusion: If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.

show abstract

A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route

Cited by 3 publications

References 10 publications

Percutaneous Ultrasound-Guided Access to the Superior Ophthalmic Vein for Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Percutaneous Ultrasound-Guided Access to the Superior Ophthalmic Vein for Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Direct Superior Ophthalmic Vein Approach to Treat Anterior Condylar Confluence Dural Arteriovenous Fistula

Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein

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