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AlAli M, Kwon B, Song Y, Lee DH. Facilitated Retrograde Access via the Facial Vein for Transvenous Embolization of the Cavernous Sinus Dural Arteriovenous Fistula with Isolated Ophthalmic Venous Drainage. Neurointervention 2024; 19:39-44. [PMID: 38213194 PMCID: PMC10910183 DOI: 10.5469/neuroint.2023.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated retrograde access via the facial vein, which is employed in the transvenous embolization of CSDAVF with isolated superior ophthalmic venous drainage. We also present illustrative cases and technical points.
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Affiliation(s)
- Meshari AlAli
- Department of Radiology, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Boseong Kwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Perng PS, Chang Y, Sun YT, Wang HK, Jiang YS, Lee JS, Wang LC, Huang CY. Endovascular treatment in bilateral cavernous sinus dural arteriovenous fistulas: a systematic review and meta-analysis. Sci Rep 2023; 13:7108. [PMID: 37528115 PMCID: PMC10394050 DOI: 10.1038/s41598-023-31864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/20/2023] [Indexed: 08/03/2023] Open
Abstract
Few studies have discussed the disease nature and treatment outcomes for bilateral cavernous sinus dural arteriovenous fistula (CSDAVF). This study aimed to investigate the clinical features and treatment outcomes of bilateral CSDAVF. Embase, Medline, and Cochrane library were searched for studies that specified the outcomes of bilateral CSDAVF from inception to April 2022. The classification, clinical presentation, angiographic feature, surgical approach, and treatment outcomes were collected. Meta-analysis was performed using the random effects model. Eight studies reporting 97 patients were included. The clinical presentation was mainly orbital (n = 80), cavernous (n = 52) and cerebral (n = 5) symptoms. The most approached surgical route was inferior petrosal sinus (n = 80), followed by superior orbital vein (n = 10), and alternative approach (n = 7). Clinical symptoms of 88% of the patients (95% CI 80-93%, I2 = 0%) were cured, and 82% (95% CI 70-90%, I2 = 7%) had angiographic complete obliteration of fistulas during follow up. The overall complication rate was 18% (95% CI 11-27%, I2 = 0%). Therefore, endovascular treatment is an effective treatment for bilateral CSDAVF regarding clinical or angiographic outcomes. However, detailed evaluation of preoperative images and comprehensive surgical planning of the approach route are mandatory owing to complexity of the lesions.
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Affiliation(s)
- Pang-Shuo Perng
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Yu Chang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Advanced Optoelectronic Technology Center, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shu Jiang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan.
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Akaike N, Ikeda H, Takada K, Uezato M, Kinosada M, Kurosaki Y, Chin M. Cavernous sinus dural arteriovenous fistula embolized through an occluded superior petrosal sinus: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE23143. [PMID: 37354434 PMCID: PMC10550532 DOI: 10.3171/case23143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Transvenous embolization for cavernous sinus (CS) dural arteriovenous fistulas (CS-DAVFs) with limitations of the major access routes to the CS is challenging. OBSERVATIONS A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS. The left inferior petrosal sinus and internal jugular vein were occluded, and no drainage route from the left superior ophthalmic vein was seen. The anterior segment of the left superior petrosal sinus (SPS) was occluded, but the posterior segment was not. Microangiography from the posterior segment of the left SPS showed a beak-like orifice in the anterior segment of the left SPS toward the left CS. A micro-guidewire was guided through the beak-like orifice, and the microcatheter was advanced into the left CS. The left CS was packed and the DAVF was occluded. LESSONS Transvenous embolization through an occluded SPS may be an option in the endovascular treatment of CS-DAVFs. Penetration along the beak-like orifice of the occluded SPS visualized by venography at the blind end of the SPS may be useful in reaching the CS via the SPS.
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Affiliation(s)
- Natsuki Akaike
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kensuke Takada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
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Naylor RM, Graepel S, Brinjikji W, Cloft H, Lanzino G. Percutaneous transorbital transvenous embolization of a cavernous sinus dural arteriovenous fistula via the superior orbital fissure-technical video. Interv Neuroradiol 2023:15910199231175023. [PMID: 37321641 DOI: 10.1177/15910199231175023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Carotid-cavernous dural arteriovenous fistulas causing debilitating ocular symptoms and/or retrograde cortical venous drainage necessitate curative treatment, which is achieved by disrupting the proximal draining vein. Transvenous embolization of carotid-cavernous dural arteriovenous fistulas can be achieved through the superior or inferior petrosal sinuses, facial veins, or superior ophthalmic veins.1, 2 However, if these approaches are not feasible, various percutaneous approaches have been described that use the skull base foramina to provide direct access to the cavernous sinus.3, 4 Here we present the case of a 54-year-old male with carotid-cavernous dural arteriovenous fistulas with cortical venous drainage causing diplopia that was cured using a percutaneous transorbital approach. We discuss the alternative endovascular strategies for treating carotid-cavernous dural arteriovenous fistulas and why they were not chosen, the technical nuances of the transorbital approach as well as the pearls and pitfalls of this seldom used technique. A comprehensive understanding of the many approaches for treating carotid-cavernous dural arteriovenous fistulas is important for neurointerventionalists.
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Affiliation(s)
- Ryan M Naylor
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Matsuda Y, Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Nishi K, Yamaoka Y, Ebisudani Y, Kimura R, Edaki H, Date I. Transvenous embolization of the direct carotid-cavernous fistula via the pterygoid plexus: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22558. [PMID: 36916525 PMCID: PMC10550643 DOI: 10.3171/case22558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Endovascular treatment is the mainstay of treatment for carotid-cavernous fistulas, but endovascular approaches vary widely. The authors report a rare case of a direct carotid-cavernous fistula with cranial nerve symptoms caused by rupture of a giant aneurysm in which selective transvenous embolization via the pterygoid plexus was performed. OBSERVATIONS An 81-year-old man presented with headache and various progressive cranial nerve symptoms due to a direct carotid-cavernous fistula caused by a ruptured giant aneurysm. All the draining veins visualized on preoperative examination immediately before the treatment were occluded except for the pterygoid plexus. Therefore, the authors chose the dilated pterygoid plexus to approach the shunted pouch at the cavernous sinus and achieve shunt obliteration by selective embolization with coils and n-butyl cyanoacrylate. LESSONS Careful study of the three-dimensional rotational images in the preoperative examination is important when considering the various approaches to surgery. The pterygoid plexus can be an effective venous approach route to reach the cavernous sinus area.
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Affiliation(s)
- Yuki Matsuda
- Department of Neurological Surgery, Miyoshi Central Hospital, Hiroshima, Japan; and
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Haruma
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiko Nishi
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoko Yamaoka
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Ebisudani
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryu Kimura
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisanori Edaki
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Raz E, Sharashidze V, Grossman S, Ali A, Narayan V, Nossek E, Stein E, Nelson PK, Shapiro M. Access to cavernous dAVF via occluded superior petrosal Sinus. Interv Neuroradiol 2023:15910199231158912. [PMID: 36843545 DOI: 10.1177/15910199231158912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
There are multiple treatment alternatives for cavernous dAVFs, with transvenous routes being most common. Among these routes, occluded inferior petrosal sinus is well-described, and, apart from being imaginative and elegant, it is also safe and effective. Herein we describe the application of this method to reach the fistulous pouch of a cavernous dAVF via an occluded superior petrosal sinus.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Vera Sharashidze
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Scott Grossman
- Department of Neurology, 12297NYU Langone Health, New York, NY, USA
| | - Aryan Ali
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Vinayak Narayan
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Erez Nossek
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Evan Stein
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Peter Kim Nelson
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Maksim Shapiro
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurology, 12297NYU Langone Health, New York, NY, USA
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Georgieva JV, Katt M, Ye Z, Umlauf BJ, Wenthur CJ, Shusta EV. The 46.1 Antibody Mediates Neurotensin Uptake into the CNS and the Effects Depend on the Route of Intravenous Administration. Pharmaceutics 2022; 14:pharmaceutics14081706. [PMID: 36015332 PMCID: PMC9414616 DOI: 10.3390/pharmaceutics14081706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Central nervous system (CNS) exposure to blood-borne biotherapeutics is limited by the restrictive nature of the brain vasculature. In particular, tightly sealed endothelial cells of the blood-brain barrier (BBB) prevent the uptake of protein and gene medicines. An approach to increase the bioavailability of such therapeutics is harnessing the BBB endothelial cells' own receptor-mediated transcytosis (RMT) mechanisms. Key to this process is a targeting ligand that can engage a BBB-resident RMT receptor. We recently identified an antibody, named 46.1, that accumulates in the mouse brain after intravenous injection. To further characterize the brain targeting and penetrating properties of clone 46.1, we conjugated neurotensin (NT) to an scFv-Fc form of the antibody (46.1-scFv-Fc-LongLinker-NT). While centrally administered NT decreases the core body temperature and locomotor activity, effects attributed to two spatially segregated brain areas, systemically administered NT has limited effects. Hence, NT can be used as a model therapeutic payload to evaluate the brain penetration of BBB-targeting antibodies and their capability to accumulate in discrete brain areas. We demonstrate that intravenously administered 46.1-scFv-Fc-LL-NT can elicit transient hypothermia and reduce drug-induced hyperlocomotion, confirming that 46.1 can deliver drug cargo to the CNS at pharmacologically relevant doses. Interestingly, when two intravenous administration routes in mice, retro-orbital and tail vein, were compared, only retro-orbital administration led to transient hypothermia. We further explored the retro-orbital route and demonstrated that the 46.1-scFv-Fc-LL-NT could enter the brain arterial blood supply directly from the retro-orbital/cavernous sinus. Taken together, the 46.1 antibody is capable of transporting drug cargo into the CNS, and at least of a portion of its CNS accumulation occurs via the cavernous sinus-arterial route.
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Affiliation(s)
- Julia V. Georgieva
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Moriah Katt
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Zhou Ye
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Benjamin J. Umlauf
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Cody J. Wenthur
- Divisions of Pharmaceutical Sciences and Pharmacy Practice, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Eric V. Shusta
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
- Correspondence:
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Cavernous Sinus Dural Arteriovenous Fistula in a Patient with Thyroid-Associated Ophthalmopathy: Complete Resolution after Medical Treatment. Brain Sci 2021; 12:brainsci12010045. [PMID: 35053788 PMCID: PMC8773681 DOI: 10.3390/brainsci12010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is a well-known and frequent epiphenomenon of a hyperthyroid autoimmune disease that can present with proptosis, strabismus, and diplopia. Ophthalmopathy can occur in the absence of overt Graves’ disease, even in euthyroid patients. Cavernous sinus dural fistulas (CS-DAVF) are abnormal communications between the cavernous sinus (CS) and dural branches from internal carotid or external carotid arteries. They can often present with ocular symptoms that can mimic a thyroid-associated ophthalmopathy. CS-DAVF are usually successfully treated with an endovascular embolization that can be pursued both through a transvenous or transarterial approach. TAO and CS-DAVF can coexist especially when the ocular symptoms are unilateral. In those cases, an endovascular embolization is usually curative, but sometimes the procedure can fail. Our hypothesis is that some cases of CS-DAVF may be of secondary nature (i.e., caused by compression of the venous outlet by the hypertrophic ocular muscles); therefore, treating the ocular disease with medical therapy may solve the vascular problem as well. We present a case of a CS-DAVF in a patient with TAO successfully treated with sole medical therapy after the failure of a first-line endovascular treatment.
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Prasad SN, Singh AP, Kanaujia V, Singh V, Phadke RV, Sharma K. Dural carotid-cavernous fistulas: our experience with endovascular management. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Indirect carotid-cavernous fistulas (CCF) are dural arteriovenous fistula of the cavernous sinus and generally present with ocular symptoms. High index of clinical suspicion and radiological work up is required for diagnosis, and treatment is primarily endovascular embolization. We present our experience in diagnosis and management of indirect CCF along with technical evolution to perform embolization and different vascular accesses for difficult anatomy.
Results
Among a total of 20 indirect CCF cases who were treated with embolization in our department from 2013 to 2020, five (25%) were type C and 15 (75%) were type D. Seven were treated with trans-arterial access only, 11 were treated by transvenous access only, and two were treated by taking both transvenous and trans-arterial access. No recurrence was seen in angiographically cured patients. Out of seven patients who suffered various grades of visual deficit, five recovered completely and two had fixed visual deficit. Third and sixth cranial nerve palsy persisted in two patients even after CCF embolization.
Conclusion
Indirect CCF is a treatable cause of troublesome ocular symptoms. Endovascular embolization is preferred treatment with excellent short- and long-term outcome. The embolization becomes difficult and challenging in cases where the conventional vascular access to the cavernous sinus is occluded.
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Padhi R, Kandasamy S, Kumaran B, Kocer N, Karmadhari H. Direct Superior Ophthalmic Vein Approach to Treat Anterior Condylar Confluence Dural Arteriovenous Fistula. Neurointervention 2021; 16:280-284. [PMID: 34662933 PMCID: PMC8561036 DOI: 10.5469/neuroint.2021.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
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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Affiliation(s)
- Rasmiranjan Padhi
- Department of Interventional Neuroradiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - Sathish Kandasamy
- Department of Interventional Neuroradiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - Balasenthil Kumaran
- Department of Neurosurgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Kim SC, Kim JH, Kim CH, Lee CY. Middle temporal vein access for transvenous embolization of Cavernous sinus dural arteriovenous fistula: A case report and review of literature. J Cerebrovasc Endovasc Neurosurg 2021; 24:44-50. [PMID: 34592805 PMCID: PMC8984642 DOI: 10.7461/jcen.2021.e2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Transvenous endovascular treatment is the first choice for treating most cavernous sinus dural arteriovenous fistulas (CDAVFs). Among several available venous routes, the inferior petrosal sinus is the most commonly used. We report a case of CDAVF treated with endovascular treatment via the middle temporal vein (MTV). A 65-year-old man presented with unilateral chemosis and exophthalmos for approximately two months. Digital subtraction angiography showed a right CDAVF with predominant venous drainage toward the right superior ophthalmic vein. The superior ophthalmic vein primarily drained into the dilated MTV. Both sides of the inferior petrosal sinus were occluded; therefore, transvenous embolization was performed via the MTV route. The fistula was completely obliterated. The patient's symptoms improved and the postoperative course was uneventful. The transfemoral approach via the MTV to treat CDAVF provides a crucial alternative when other venous routes are difficult or impossible to navigate with a catheter.
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Affiliation(s)
- Su-Chel Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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