Abstract TP447: Transvenous Approach Of Cavernous Sinus Dural Arteriovenous Fistula
Background: Transvenous embolization (TVE) for cavernous sinus dural arteriovenous fistula (CSdAVF) is commonly performed via inferior petrosal sinus (IPS). However, TVE via IPS is sometimes difficult and we have to use adjunctive techniques or choose other approach routes.
Method: 44 patients with CSdAVFs were treated by TVE between January 2005 and June 2012. We retrospectively analyzed their techniques and approach routes.
Result: The approach via IPS was possible in 37 patients (84%). 5 patients of them were treated via contralateral IPS of the lesions and 17 patients of them were treated via occluded IPS. As the adjunctive technique, we used triple catheter technique (TCT) in 11 patients, and the reopening technique using 0.035-inch guidewire, which opened a path for a subsequently inserted microcatheter in 6 patients. 7 patients (16%) were treated via the other approach routes. In 4 patients, we approached via facial vein. In 2 patients, we approached via middle temporal vein. In 1 patient, we approached via superior petrosal sinus and IPS at the same time using double catheter technique. As the adjunctive technique, we used TCT in 5 patients, direct puncture of internal jugular vein in 1 patient, compression of facial-angular vein in 1 patient. All of 43 patients were treated with coils and 2 patients were treated with N-butyl-2-cyanoacrylate (NBCA) which was injected to the inside of the sinus as additional treatment. Finally, complete occlusion was achieved in all of 43 patients.
Conclusion: Adjunctive techniques enable us to access cavernous sinus via IPS in most of our patients. If it is impossible to access cavernous sinus via IPS, we must analyze vascular anatomies and choose appropriate approach routes.
- © 2012 by American Heart Association, Inc.