Endovascular Occlusion of Dural Cavernous Fistulas through a Superior Ophthalmic Vein Approach

Briganti, Francesco; Caranci, Ferdinando; Leone, Giuseppe; Napoli, Manuela; Cicala, Domenico; Briganti, G.; Tranfa, Fausto; Bonavolontà, Giulio

doi:10.1177/197140091302600510

Cited by 12 publications

(3 citation statements)

References 36 publications

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“…[ 20 ] However, when the IPS is inaccessible or it is difficult to treat the CSDAVF with TVE through the IPS route, various alternative access routes, such as the superior petrosal sinus,[ 16 ] the pterygoid plexus,[ 9 ] the facial vein (FV),[ 3 , 13 ] and the STV,[ 8 ] have been reported. The usefulness of direct puncture of the SOV,[ 2 ] FV,[ 1 , 15 ] STV,[ 11 ] and frontal vein,[ 19 ] and direct puncture of the Sylvian vein by craniotomy[ 14 ] has also been reported.…”

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.

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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

View full text Add to dashboard Cite

show abstract

“…Transvenous embolization is the first-line treatment for CSdAVF because of a high radical cure rate. Occasionally, however, a large number of coils are necessary for sinus packing, or frontal vein, 13) retromandibular vein, 14) superficial temporal vein, 13,15) direct puncture of the SOV by supraorbital incision, direct sinus packing with craniotomy, 16,17) and direct puncture of the superficial middle cerebral vein. 18,19) In addition, techniques such as pulling up the micro-catheter from the contralateral IPS using a gooseneck snare 20) have been reported.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cavernous Sinus Dural Arteriovenous Fistula Treated by Transfacial Vein Placement of a Distal Access Catheter in the Cavernous Sinus

Chihara

Sadamasa

Yang

et al. 2017

JNET

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Objective: The first choice for the treatment of cavernous sinus dural arteriovenous fistula (CSdAVF) is transvenous embolization. The inferior petrosal sinus (IPS) approach is commonly used, but modification of the procedure is necessary in patients with IPS occlusion. We treated one patient by guiding a distal access catheter (DAC) to the cavernous sinus by the transfacial vein approach through the superior ophthalmic vein and obtained a favorable outcome.Case Presentation: A 68-year-old woman with CSdAVF presented with ophthalmic symptoms. All feeding arteries converged in a pouch on the superior aspect of the medial posterior segment, and the superior ophthalmic vein/facial vein was the only drainage route. A 3.4 Fr TACTICS used as a DAC in a triple coaxial system was placed in the cavernous sinus via the facial and superior ophthalmic veins, a micro-catheter was navigated to the shunted pouch, and CSdAVF was embolized with two coils. Conclusion: 3.4 Fr TACTICS is useful as a DAC in the transfacial vein approach to CSdAVF through the superior ophthalmic vein.Keywords▶ cavernous sinus dural arteriovenous fistula, transfacial vein approach through the superior ophthalmic vein, selective transvenous embolization, distal access catheter, TACTICS

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“…Multiple endovascular routes to the cavernous sinus have been described, including via the inferior petrosal sinus, superior petrosal sinus, facial and ophthalmic veins, pterigoid plexus, and the vein of Labbe´. [1][2][3][4][5][6][7][8][9][10][11] In addition to endovascular routes, a direct puncture of other accesses to the cavernous sinus have also been described, such as a puncture of ophthalmic veins, the foramen ovale, and the superficial middle cerebral vein, in addition to a transorbital puncture of the cavernous sinus. [12][13][14][15][16] Although a cure for DCCF can be achieved with an occlusion of the fistula compartment using coils and/or liquids, reaching the DCCF compartment is one of the most technically challenging steps in DCCF treatment.…”

Section: Introductionmentioning

confidence: 99%

The routes for embolization of dural carotid cavernous fistulas when the endovascular approach is indicated as a first-line strategy

et al. 2018

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Introduction Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. Methods A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. Results The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%). Conclusions In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.

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Endovascular Occlusion of Dural Cavernous Fistulas through a Superior Ophthalmic Vein Approach

Cited by 12 publications

References 36 publications

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

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

A Case of Cavernous Sinus Dural Arteriovenous Fistula Treated by Transfacial Vein Placement of a Distal Access Catheter in the Cavernous Sinus

The routes for embolization of dural carotid cavernous fistulas when the endovascular approach is indicated as a first-line strategy

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