FIG 1. Ninety-one-year-old woman (case 10 [Table 1]), 2 months after radiation therapy for nasopharyngeal carcinoma develops a slowly progressive right orbital swelling, chemosis, proptosis, and ophthalmoplegia. Angiogram shows a CCF with mixed dural artery supply via both ECA (type C, ref. 2). There is a retrograde venous drainage via the right ophthalmic vein and right cerebellar cortical veins. A transvenous n-BCA embolization combined with coils was carried out with successful dural CCF obliteration and complete clinical recovery.

A, Right lateral ECA angiogram shows incomplete filling of the CS (arrowheads) and SOV (straight arrow). Discrete retrograde filling of the congested anterior cerebellar vein is noted (double arrows). Note there is no filling of the IPS.

B, Placement of a 5F guide catheter over a wire through the obliterated IPS into the posterior-lateral segment of the CS.

C, Right lateral CS venogram shows a proximal stenosis of the congested SOV (arrow) as source for the clinical symptoms and filling of cerebellar cortical veins (arrowheads) via proximal superior petrosal vein (double arrow). Note the guide catheter is occlusive within the IPS.

D, Lateral radiograph shows several coils placed in the CS for flow reduction and to protect acrylate spillage into SOV and anterior cerebellar veins.

E, Lateral radiograph shows coils and n-BCA-Ethiodol cast of the entire CS segment depicted in panels A and C, proximal SOV (arrow), and the superior petrosal vein (double arrow).

F and G, Early- and late-phase right lateral CCA angiograms show CCF obliteration.