Transfemoral trans-facial vein-superior ophthalmic vein to embolize cavernous sinus dural arteriovenous fistulas

Abstract

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal communication between the CS and dural arteries from the internal carotid artery and external carotid artery. CS-DAVFs are not uncommon. The preferred treatment for most CS-DAVFs is transvenous embolization (TVE), which can achieve a high cure rate with few complications. The trans-inferior petrous sinus (IPS) route from the internal jugular vein to the CS is the favorite and most direct route to perform TVE in the great majority of CS-DAVFs. However, when the trans-IPS route fails and if the facial vein (FV) is patent and dilated, transfemoral trans-FV-superior ophthalmic vein (SOV) embolization of the CS-DAVF can be attempted. However, the transfemoral trans-FV-SOV route to embolize CS-DAVFs is often challenging, and there is insufficient knowledge about it. Therefore, an updated review of the transfemoral trans-FV-SOV route to embolize CS-DAVFs is necessary, and this review includes our experience. The images in this review are from our institute without the dispute of copyright. Issues regarding the transfemoral trans-FV-SOV route to embolize CS-DAV were discussed, including the FV anatomy and variation, various TVE routes to access CS-DAVF, the procedure of the transfemoral trans-FV-SOV route to embolize CS-DAVF, difficulty, and solution of the transfemoral trans-FV-SOV route to embolize CS-DAVF, and complications and prognosis of transfemoral trans-FV-SOV to embolize CS-DAVF. By reviewing the transfemoral trans-FV-SOV route to embolize CS-DAVFs, we found that this route provides a valuable alternative to the other transvenous routes. A good prognosis can be obtained with the transfemoral trans-FV-SOV route to embolize CS-DAVFs in select cases.

Cavernous sinus dural arteriovenous fistula treated with transvenous embolization through facial vein: A case report

“…[ 2 , 9 ] However, there are some cases in which the IPS is occluded. [ 13 , 15 ] There is an alternative approach to reach the CS through the occluded IPS, but the success rate is 54–80%,[ 4 , 13 ] and there have been some cases that are difficult to treat. Various approaches other than IPS have been reported,[ 2 , 11 ] including FV.…”

“…[1,3,8,10] One problem with this approach is that the FV is a long vessel with strong tortuosity, so it is necessary to select a catheter and connector appropriately. It has been reported that about 9% of cases drain into the external jugular vein, [5,15] so it is important to evaluate the approach route using preoperative CTV. In addition to CTV, magnetic resonance imaging and 3D-digital subtraction angiography (DSA) are also useful for preoperative assessment of the approach route.…”

“…[ 2 , 9 ] However, there are cases in which the IPS is occluded. [ 13 , 15 ] In such cases, other routes must be chosen. One of such routes is the facial vein (FV).…”