Transvenous embolization of dural caroticocavernous fistulae: technical considerations

Abstract

Sixteen patients with symptomatic dural caroticocavernous fistulae were treated by transvenous embolization, via the jugular vein and inferior petrosal sinus. The fistula was occluded by thrombogenic coils. Complete resolution of symptoms and signs was achieved in 14 patients, and complete angiographic resolution was also obtained in 14 patients. Failures to achieve angiographic cure were attributed to failure to reach the fistula within the cavernous sinus precisely. Factors which make placement of the catheter at the fistula difficult are trabeculae within the cavernous sinus, a specific configuration of the superior ophthalmic vein and venous thrombosis. To improve the efficacy of transvenous embolization, every possible venous route to the cavernous sinus therefore should be tried, to facilitate reaching the fistula and the possibility of transvenous embolization should not be thwarted by venous thrombosis.

Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations

“…That is, all the results for the patients t reated with the transarterial approach only were classified as failures, while for 61% of the patients, t reated with a transvenous approach, the re s u l t s w e re successful. This information agrees with the experiences of some authors who advocate the transvenous approach as the method of choice to achieve clinical and angiographic cure for DAV M s of the cavernous sinus 19,20,22,24 .…”

Comparison of the Risk of Oculomotor Nerve Deficits between Detachable Balloons and Coils in the Treatment of Direct Carotid Cavernous Fistulas

“…Debrun et al 10 reported a 20% incidence of transient oculomotor nerve palsy, which is usually attributable to sixth cranial nerve dysfunction. 11 For DCCFs that are not successfully treated with ICA preservation by using a detachable balloon, transarterial GDC embolization is an alternative treatment. In 1992, Guglielmi et al 12 successfully treated DCCFs by transvenous GDC embolization, and there have been several subsequent reports of transarterial GDC embolization of DCCFs with favorable results.…”

Endovascular Approaches to the Carotid Cavernous Sinus for Endovascular Treatment of Carotid Cavernous Fistulas and Hormone Sampling

“…Various kinds of venous approaches have been reported: the inferior petrosal sinus (IPS) route was the first established and most commonly used [4][5][6] , especially for venous hormone sampling 2,3 . When the ophthalmic vein [7][8][9][10][11][12][13][14][15][16][17][18][19][20] , superior petrosal sinus (SPS) 21 and pterigoid plexus (PP) 22 are involved in venous drainages of CCFs, each venous channel may become an appropriate access route.…”

“…Yamashita et al 6 reported complications occurring in 7 of 16 patients with TVE. One was epidural extravasation from perforation of the inferior petrosal sinus.…”