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

Abstract

We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres.

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

“…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.…”

Venous Procedures

“…ii) Puncture of the frontal vein in the forehead. 63 iii) Puncture of super fi cial temporal vein in the temporal scalp. 64 6) When transfemoral venous access via the IPS or cutdown to expose the SOV is not possible, other routes of entry may be required.…”

Endovascular Management of Intracranial Dural Arteriovenous Fistulas

“…Several unique transvenous embolization options have been reported for cavernous sinus dAVFs and include access via the pterygoid plexus, 45 puncture after surgical exposure of the superior ophthalmic vein, 46-50 direct puncture of the superior 51 and inferior ophthalmic veins, 52-54 facial vein puncture, and access via a frontal vein. 55 Detachable balloons were previously used for both transvenous 35,47,56,57 and transarterial embolization of low-flow dAVFs 6 but are no longer available in the United States. Percutaneous embolization of the cavernous sinus via the superior orbital fissure was first reported by Teng and colleagues.…”