FIG 2. Eighty-seven-year-old woman (case 4, Table 1) presented with progressive ophthalmoplegia, decreased visual acuity, and chemosis. Angiogram shows a CCF with bilateral mixed dural artery supply both via the external and internal carotid arteries (type D, ref. 2), congestion of both cavernous segments with retrograde flow in both SOV. A transvenous embolization was carried out by using n-BCA with complete CCF obliteration and cure of symptoms.

A–D, Early- and late-phase right lateral and frontal ICA angiograms show slow contrast filling (A, thin double arrow) through dural branches of the ICA (A, arrow) including capsular arteries of McConnell at the floor of sella turcica. Retrograde filling of the SOV (arrowhead) with origin stenosis (B and C, double arrows). Note delayed contrast washout (B–D, arrows) of the CS bilaterally.

E and F, Frontal and lateral radiographs show the microcatheter in the left cavernous segment (arrow) before n-BCA infusion. Microcatheter was navigated through the SOV (double arrow) and the anterior intercavernous connection (arrowhead).

G and H, Frontal and lateral radiograph show the n-BCA-Ethiodol cast within the CS bilaterally. Some embolic material spillage is seen in the right proximal SOV through the stenotic segment (arrow). Note the radiolucent structures within the glue cast represent the internal carotid arteries.

I–L, Left lateral early and late phase ICA angiograms (I and J) and right and left frontal angiogram show CCF obliteration. Note artifacts related to the embolic material (arrows).