Transcortical Venous Approach for Direct Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Chaudhary, Navjot; Lownie, Stephen P.; Bussiére, Miguel; Pelz, David M.; Nicolle, David A.

doi:10.1227/neu.0b013e31823fcc6e

Cited by 23 publications

(27 citation statements)

References 14 publications

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“…Conventional guide catheters are too rigid to navigate deeply into the venous sinus anatomy from a transfemoral approach. Alternatively, direct venous sinus access can be obtained with a burr hole craniotomy,2 27 29 30 but this adds surgical morbidity and carries a significant risk of bleeding complications, especially in the setting of anticoagulation. For these reasons, the mainstay treatment of anterior fossa dAVF has remained surgical disconnection and few centers offer endovascular obliteration.…”

Section: Discussionmentioning

confidence: 99%

Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae

Spiotta

Hawk

Kellogg

et al. 2013

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae

Spiotta

Hawk

Kellogg

et al. 2013

J NeuroIntervent Surg

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“…A stereotactically placed burr hole can allow direct puncture of a cortical draining vein or the fistula itself. 25,26 Another option requires direct surgical cut-down to expose a vessel for more proximal access to a fistula. Cut-down to the superior division of the ophthalmic vein via a small incision on the eyelid can be performed safely in the angiography suite by an ophthalmologist.…”

Section: Approaches To Davf Embolizationmentioning

confidence: 99%

Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas

et al. 2014

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Endovascular treatment options for dural arteriovenous fistulas (DAVFs) have vastly expanded and become progressively safer in the last several years. Angiographic imaging systems have improved, catheter technology has advanced, and liquid embolic and coil options have increased. As a likely result, an increasing proportion of DAVFs are treated via an endovascular approach. In addition to allowing physicians to appreciate and treat lesions better, varied approaches have been developed. The "plug and push" technique and the new availability of dimethyl sulfoxide--compatible dual lumen balloons have allowed safer and more thorough transarterial treatments. Transvenous treatment has proved to be a valuable technique for some lesions. Hybrid approaches with surgical assisted access to vascular structures have been successfully used to treat more challenging fistulas.

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“…[15][16][17] Direct puncture of the cortical vein after craniotomy was also proposed. 18 Transarterial injection of Onyx to occlude DAVFs of the cavernous sinus is limited by possible embolic complications related to the numerous anastomoses between the most frequent arterial feeders to the fistula (middle meningeal artery, accessory meningeal artery, internal maxillary artery, and neuromeningeal branch of the APA) and the carotid siphon or the ophthalmic artery through their meningeal branches to the cavernous sinus. Moreover, there is the risk of cranial nerve palsies due to compression in the osseous foramina or to ischemic injury related to occlusion of the vasa nervorum.…”

Section: Discussionmentioning

confidence: 99%

Onyx embolization of dural arteriovenous fistulas of the cavernous sinus through the superior pharyngeal branch of the ascending pharyngeal artery

Pero

Quilici²,

Piano³

et al. 2014

BMJ Case Reports

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We report three cases of dural arteriovenous fistula (DAVF) of the cavernous sinus treated by Onyx injection through the superior pharyngeal branch of the ascending pharyngeal artery. The treatment of choice of DAVFs of the cavernous sinus is endovascular, and it is preferentially done via transvenous occlusion of the cavernous sinus. The cavernous sinus can be reached through either the inferior petrosal sinus or the superior ophthalmic vein. When these venous routes are occluded, the first attempt is to pass through the occluded inferior petrosal sinus, but sometimes this attempt can fail. In some cases there are small transosseous feeders to the fistula arising from the superior pharyngeal branch of the ascending pharyngeal artery. When all of the more conventional approaches are unattainable, this route can be attempted. In our experience, it allowed safe and rapid occlusion of the fistula.

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Transcortical Venous Approach for Direct Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Abstract: This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible.

Cited by 23 publications

References 14 publications

Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae

Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae

Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas

Onyx embolization of dural arteriovenous fistulas of the cavernous sinus through the superior pharyngeal branch of the ascending pharyngeal artery

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