Abstract
There are multiple transvenous approaches for treatment of cavernous dural arteriovenous fistulae (DAVF). The choice of a specific route depends on the compartment of the cavernous sinus involved in the fistula and its venous drainage. We used two different facial vein approaches to treat patients with cavernous DAVF draining directly into the anterior compartment of the cavernous sinus and thence to the superior ophthalmic vein. Other transvenous routes to the sinus were not apparent. Embolization was targeted to the involved compartment with preservation of those not embolized. No major post-procedure ophthalmic venous engorgement occurred. We believe that ideal treatment of cavernous DAVF is targeted transvenous coil deposition, which necessitates detailed knowledge of the anatomy of the facial veins and cavernous sinus compartments.
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References
Kinugasa K, Tokunaga K, Kamata I, et al (1994) Selection and combination of techniques for treating spontaneous carotid-cavernous sinus fistulas. Neurol Med Chir 34: 597–606
Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Pribram H (1989) Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR 10: 377–383
Roy D, Raymond J (1997) The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40: 1133–1141
Davies MA, terBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC (1996)The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85: 830–837
van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC (2002) Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 33: 1233–1236
Albuquerque FC, Heinz GW, McDougall CG (2003) Reversal of blindness after transvenous embolization of carotid cavernous fistula: case report. Neurosurgery 52: 233–237
Viñuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG (1984). Spontaneous cavernous-carotid fistula: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60: 976–984
Halbach VV, Higashida RT, Hieshima GB, Hardin CW (1989). Embolization of branches arising from the cavernous portion of the internal carotid artery. AJNR 10: 143–150
Nakamura M, Tamaki N, Kawaguchi T, Fujita S (1998) Selective transvenous embolization of dural carotid-cavernous sinus fistulas with preservation of sylvian venous outflow. Report of three cases. J Neurosurg 89: 825–829
Usami S, Abe T, Hata Y (1997). Classification of the venous route of carotid cavernous fistula. Intervent Neuroradiol 3 [Suppl 2]: 93–96
Quiñones D, Duckwiler G, Gobin PY, Goldberg RA, Viñuela F (1997) Embolization of dural cavernous fistulas via superior ophthalmic vein approach. AJNR 18: 921–928
Yamashita K, Taki W, Nishi S, et al (1993) Transvenous embolization of dural caroticocavernous fistulae: technical considerations. Neuroradiology 35: 475–479
Miller NR, Monsein LH, Debrun GM, Tamargo RJ, Nauta HJW (1995) Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83: 838–842
Benndorf G, Bender A, Lehmann R, Lanksch W (2000) Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature. Surg Neurol 54: 42–54
Mounayer C, Piotin M, Spelle L, Moret J (2002) Superior petrosal sinus catheterization for transvenous embolization of a dural carotid cavernous sinus fistula. AJNR 23: 1153–1155
Jahan R, Gobin YP, Glenn B, Duckwiler GR, Viñuela F (1998) Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus. Neuroradiology 40: 189–193
Kohyama S, Kaji T, Tokumaru AM, Kusano S, Ishihara S, Shima K (2002) Transfemoral superior ophthalmic vein approach via the facial vein for the treatment of carotid-cavernous fistula -- two case reports. Neurol Med Chir 42: 18–22
Mizuno T, Kai Y, Todaka T, Morioka M, Hamada J, Ushio Y (2001) Treatment of spontaneous carotid-cavernous fistula by the transvenous route. No Shinkei Geka 29: 961–964
Naito I, Magarisawa S, Wada H (2002) Facial vein approach by direct puncture at the base of the mandible for dural carotid cavernous fistula: an alternative to the superior ophthalmic vein approach: A case report. Intervent Neuroradiol 8: 67–70
Benndorf G, Lehmann TN, Molsen HP, Lanksch W, Felix R (1999) Puncture of the superficial sylvian vein for embolization of cavernous dural arteriovenous fistula. Intervent Neuroradiol 5: 167–170
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Agid, R., Willinsky, R.A., Haw, C. et al. Targeted compartmental embolization of cavernous sinus dural arteriovenous fistulae using transfemoral medial and lateral facial vein approaches. Neuroradiology 46, 156–160 (2004). https://doi.org/10.1007/s00234-003-1131-9
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DOI: https://doi.org/10.1007/s00234-003-1131-9