Endovascular treatment of dural fistulas with the venous outflow of laterocavernous sinus
Introduction
LCS is a venous structure located in between the two dural layers forming the lateral wall of the CS and LCS has recently been described as one of the principal drainage pathways of SMCV [7], [20], [21]. LCS is readily identified angiographically on the anteroposterior (AP) projection as a slit-like structure draining the SMCV toward the pterygoid plexus (PP) and the transverse sinus (TS) via the superior petrosal sinus (SPS) [7] (Fig. 1B). LCS is the outermost venous structure of the laterosellar region, separated from the lateral compartment of CS by the inner dural layer of the lateral wall of CS [21]. This inner layer may be seen as a thin vertical opacification defect between the LCS and the lateral compartment of CS when these venous spaces are visible together [7]. The two structures, CS and LCS are separate anatomic entities with distinct functional and clinical implications [21]. LCS is one of the principal drainage pathway of SMCV [20], [21]. Venous structures of LCS other than CS may also be involved in a dural fistula, either independently or in conjunction with the CS, and may represent a diagnostic pitfall with important implications for the planning and success of the endovascular procedure [7], [21], [22]. We present 7 cases of a DAVF involving the LCS directly or indirectly, focusing our attention on the important clinical implications of this venous compartment.
Section snippets
Methods
From 2005 to 2008, consecutive 32 patients with dural fistulas of paracavernous sinus region were treated with endovascular techniques at our institution. Of these patients, 7 patients harbored dural fistulas involving the LCS with SMCV drainage. The characteristics, methods of treatment, and approach of the 6 patients are summarized in Table 1. There were two 2 men and 5 women age 22–55 years (mean, 42 years). Primary presenting symptoms included proptosis, chemosis, ophthalmoplegia,
Results
Six patients underwent immediate obliteration of the dural fistulas. One patient demonstrated complete AVF obliteration at 7-month follow up after incomplete transarterial embolization. Procedures were performed preferably with general anesthesia. Patient 1 had a dural fistula involving the lesser sphenoid wing supplied by external carotid artery (ECA) branches and dural branches of the ophthalmic artery (OA) from ipsilateral internal carotid artery (ICA) with LCS and leptomeningeal veins
Discussion
LCS derives from the primitive tentorial sinus, which drains cortical blood coming from the SMCV, migrates medially toward the CS region at the time of formation of the lateral wall of the CS, during the 8th week of gestation [21]. In the previous study, LCS was found in 24.1% of the cases [21]. In the present study, laterocavernous was found in 21.9% of the cases with dural fistulas of the paracavernous sinus region. LCS drained itself principally into the SPS or PP as well as communicate with
Conclusion
CCFs involving the LCS need to be recognized as a separate entity from CS CCFs. Failure to angiographically recognize a DAVF of the LCS may lead to the erroneous diagnosis of a CS CCFs, and a subsequent attempt to perform a transvenous embolization of the CS. Such a procedure will not only have no effect on the arteriovenous shunt on the LCS, but may, in patients in whom the CS represents the major outflow of the LCS, increase retrograde filling of the cerebral veins, placing the patient at a
References (22)
- et al.
Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature
Surg Neurol
(2000) - et al.
The efficacy and safety of transvenous embolisation in the treatment of intracranial dural arteriovenous fistulas
J Clin Neurosci
(2001) - et al.
Traumatic middle meningeal artery and fistula formation with the cavernous sinus: case report
Surg Neurol
(2008) - et al.
Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula
Eur J Radiol
(2009) - et al.
Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up
Am J Ophthalmol
(2002) - et al.
Endovascular approach to treatment of indirect carotico-cavernous fistulae
Br J Neurosurg
(2001) - et al.
Transvenous sonographically guided percutaneous access for treatment of an indirect carotid cavernous fistula
AJNR Am J Neuroradiol
(2003) - et al.
Carotid cavernous fistula: embolization via a bilateral superior ophthalmic vein approach
AJNR Am J Neuroradiol
(2002) - et al.
Cavernous sinus dural fistulae treated by transvenous approach through the facial vein: report of seven cases and review of the literature
AJNR Am J Neuroradiol
(2003) - et al.
Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases
Acta Neurochir
(2003)
Angiographic anatomy of the laterocavernous sinus
AJNR Am J Neuroradiol
Cited by (10)
The laterocavernous sinus system: Venous inflows, venous outflows, and clinical significance
2011, World NeurosurgeryCitation Excerpt :Laterocavernous sinus (LCS) is the outermost venous structure of the laterosellar region, separated from the lateral compartment of cavernous sinus (CS) by the inner dural layer of the lateral wall of the CS (13, 18). LCS as an accessible compartment has been selectively used for embolization of cavernous dural arteriovenous fistulas (13, 19); however, neuroradiologists generally do not fully appreciate the clinical importance of its territory. LCS, although small, includes several important deep-tissue extracranial and intracranial structures involved in a variety of disease processes (17).
Middle cranial fossa non-cavernous sinus dural arteriovenous fistulas: 20 years of experience
2024, Neurosurgical ReviewEndovascular treatment for sphenoidal region dural arteriovenous fistula
2024, Frontiers in NeurologyClassifications of Cranial and Spinal Dural Arteriovenous Fistulas and Their Endovascular Embolization
2022, Intracranial and Spinal Dural Arteriovenous FistulasDural arteriovenous fistulas and scheme grading systems
2021, Craniospinal Vascular Diseases and Endovascular Neurosurgery