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 20 publications

(28 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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show abstract

“…Once the guidewire reaches the CS, it can be removed and a microcatheter brought up over a microwire through the channel it created. In a variation of this technique, 33) the 0.035″ hydrophilic guidewire is used to probe the orifice of the IPS and then advanced into the occluded IPS. A jugular venographic roadmap is obtained with the wire in place, and then the wire is removed leaving a bright line on the roadmap from the wire tract through the IPS.…”

Section: Cannulation Of the Csmentioning

confidence: 99%

Transvenous Approaches to Embolization of Dural Arteriovenous Fistulae of the Cavernous Sinus

Guest

Krings

2022

JNET

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Dural arteriovenous fistulae of the cavernous sinus (CS) (previously often referred to indirect carotid cavernous fistulas) are rare vascular shunts involving meningeal branches and osseous branches of the external or internal carotid arteries and the CS. They typically present with ocular symptoms including pain, conjunctival injection, and proptosis. Left untreated there may be a risk of vision loss, and fistulas with cortical venous reflux through either the deep or superficial venous system may cause intracranial venous congestion or hemorrhage. Endovascular embolization is the standard treatment, and while transarterial routes may appear possible, transarterial embolization has considerable risks of ischemic complications. Conversely, transvenous routes achieve a high rate of fistula occlusion with a low risk of periprocedural morbidity. Procedural success depends on identification of the venous outflows from the fistula and localization of the fistulous point, to select the best route of access to the CS, including the inferior petrosal sinus (IPS), intercavernous sinus, or superior ophthalmic vein, among others. Even if the IPS is not visualized, it may be possible to recanalize it to gain access to the CS. Embolization can be performed with a combination of coils, fibered coils, and liquid embolic agents, focusing on occlusion of the fistulous point or blocking high-risk venous outflow pathways. In this review we will highlight procedural pearls and potential pitfalls and our typical approach to these lesions based on illustrative examples.

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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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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 20 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

Transvenous Approaches to Embolization of Dural Arteriovenous Fistulae of the Cavernous Sinus

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

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