Cannulation of Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: Usefulness of a Frontier-Wire Probing Technique

Jia, Zhen; Song, Yunsun; Sheen, Jae Jon; Kim, Joong-Goo; Lee, Deok Hee; Suh, Dae Chul

doi:10.3174/ajnr.a5868

Cited by 22 publications

(35 citation statements)

References 11 publications

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“…The contralateral IPS can also serve as an alternative route [15,49]. 3D rotational venography of the internal jugular vein (IJV) is very useful for revealing the details of the IPS and creating a plan to pass it [43,50]. In addition, preoperative CT angiography (CTA) can also help to localize the IPS [51].…”

Section: Transfemoral Venous Approachmentioning

confidence: 99%

“…During reopening the IPS, a standard hydrophilic-polymerjacketed 0.035-inch guidewire can advance as a frontier wire for probing the IPS. Then, the trace of the guidewire on the roadmap image can serve as a guide for microcatheter navigation through the IPS [27,50]. In addition, the microwire looping technique for breaching the occluded IPS under the reinforcement of guiding system support is also helpful, during which the 5F catheter fixed to the outlet of IPS provides a stable support [29,51,52].…”

Section: Transfemoral Venous Approachmentioning

confidence: 99%

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Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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A cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication involving the dura mater within or near the CS wall. The dural arteries from the internal carotid artery and external carotid artery supply the CS-DAVF, and the superior ophthalmic vein (SOV) and inferior petrous sinus (IPS) are frequent venous drainers. In CS-DAVF cases, high-risk lesions require treatment. Endovascular treatment (EVT) has been the first-line option for CS-DAVFs. To our knowledge, a review of the EVT of CS-DAVFs is lacking. Therefore, in this paper, we review the available literature on this issue. In addition, some illustrative cases are also provided to more concisely expound the EVT of CS-DAVFs. According to the recent literature, transvenous embolization via the IPS is considered the most effective method for EVT of CS-DAVFs. In addition, the transorbital approach is another reasonable choice. Other venous approaches can also be tried. Because of the low cure rate, transarterial embolization for CS-DAVFs is limited to only highly selected patients. In the EVT of CS-DAVFs, various agents have been used, including coil, Onyx, and n-butyl cyanoacrylate, with coil being the preferred one. In addition, when EVT cannot obliterate the CS-DAVF, stereotactic radiotherapy may be considered. In general, despite various complications, EVT is a feasible and effective method to manage CS-DAVFs by way of various access routes and can yield a good prognosis.

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Section: Transfemoral Venous Approachmentioning

confidence: 99%

Section: Transfemoral Venous Approachmentioning

confidence: 99%

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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“…20,21) If advancement of the GC is difficult, the trace of the guidewire on the roadmap image can be used as a landmark for microcatheter navigation through the IPS. 22)…”

Section: Transvenous Embolizationmentioning

confidence: 99%

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulae: Review of the Literature and Current Status

Satow

2020

JNET

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Cavernous sinus dural arteriovenous fistulae (CSdAVFs) are characterized by the shunts between dural arteries and dural veins surrounding the cavernous sinus (CS), causing ocular symptoms in addition to intracranial hemorrhage and infarction.As surgical access is difficult, endovascular treatment (EVT) has been considered and performed as the first-line therapy for decades. Although there have been recent advances in techniques and devices, transvenous embolization (TVE) with platinum coils remains the most common procedure. There are multiple access routes to the CS, such as the inferior petrosal sinus, superior ophthalmic vein (SOV), and intercavernous sinus from the contralateral CS. To extirpate the shunt, packing the entire sinus with coils is adopted, occasionally resulting in persistent cranial nerve palsy (CNP) due to compression of the coil mass.To avoid this complication, selective shunt occlusion (SSO), in which the coils are placed in the shunted pouch (SP) defined by the small restricted space where the arterial flow converges, is an effective and safe method. Transarterial embolization (TAE) is another option and use of liquid embolic materials, such as Onyx may be promising; however, the potential risk of ischemic nerve injury due to undesirable ante/retrograde influx of the liquid materials is of concern. In conclusion, EVT, especially TVE, is a safe and effective method for managing CSdAVFs. Understanding the angioanatomy consisting of the feeding artery, shunt point, and the drainage route, including the latent vessels, is essential for a good outcome. Keywords▶ cavernous sinus, dural arteriovenous fistulae, endovascular treatment, transvenous embolizationThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…[7][8][9][10][11] Some authors reported to use 0.035-inch polymerjacketed guidewires (Radifocus, Terumo, Tokyo, Japan) to enter the IPS for their better controllability and more support than a microguidewire. 12 However, the potential complication of venous injury in the posterior fossa may be encounted. 12 The purpose of this study was to report our experience using the angle of the microguidwire on the lateral projection under uoroscopic image for cannulating occluded IPSs in patients undergoing TVE of CSDAVFs.…”

Section: Introductionmentioning

confidence: 99%

“…12 However, the potential complication of venous injury in the posterior fossa may be encounted. 12 The purpose of this study was to report our experience using the angle of the microguidwire on the lateral projection under uoroscopic image for cannulating occluded IPSs in patients undergoing TVE of CSDAVFs.…”

Section: Introductionmentioning

confidence: 99%

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

2021

Preprint

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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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Cannulation of Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: Usefulness of a Frontier-Wire Probing Technique

Cited by 22 publications

References 11 publications

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulae: Review of the Literature and Current Status

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

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