Endovascular Embolization of a Paracavernous Arteriovenous Fistula Through a Cortical Venous Access: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Yosuke Akamatsu ◽  
Santiago Gomez-Paz ◽  
Justin M Moore ◽  
Ajith J Thomas ◽  
Christopher S Ogilvy
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Venous Access ◽  
Endovascular Embolization ◽  
Cerebral Veins ◽  
Sagittal Sinus ◽  
Venous Structure ◽  
Efficient Alternative ◽  
The Right

Abstract We present the case of a 62-yr-old female with a right bulging eye and intermittent headaches. A T2 weighted magnetic resonance image revealed a dilated serpiginous vessel in the right orbit and abnormal flow voids lateral to the orbital apex. The right internal carotid contrast injection demonstrated a dural arteriovenous fistula (dAVF) fed by the ophthalmic artery and drainage into the ipsilateral superficial middle cerebral veins (SMCVs) and the basal vein of Rosenthal without opacification of the cavernous sinus. A fistulous pouch was identified anterolateral to the carotid siphon. The venous phase of the left internal carotid injection demonstrated the bilateral cavernous sinuses, suggesting no involvement of the cavernous sinus with the fistula. Concerning the risk of future hemorrhagic events, endovascular treatment was recommended. Considering the robust connection of the cortical draining vein with the superior sagittal sinus (SSS), a transvenous embolization was performed. The lesion was accessed through the SSS and the right SMCV and embolized with platinum coils, resulting in complete fistula obliteration without any complications. The SMCVs can drain into paracavernous venous structure, which independently presents lateral to cavernous sinus.1,2 Because incomplete embolization of this fistula through cavernous sinus can alter the shunt flow toward cerebral veins, we did not get into the fistula site through the cavernous sinus using conventional methods. Transvenous access through a cortical bridging vein is an efficient alternative for endovascular embolization of paracavernous dAVFs. Patient approval and consent was obtained prior to the procedure and for submission of this article.

scholarly journals Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature

2019 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Robin Bhattarai ◽  
Chuan Chen ◽  
Chao Feng Liang ◽  
Teng Chao Huang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Treatment Effectiveness ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Balloon Occlusion ◽  
The Right

We summarize the treatment effectiveness and experience of a patient who underwent internal carotid balloon occlusion combined with Intermediate-flow bypass as a treatment for large-giant cavernous sinus segment internalcarotid artery (CS ICA) aneurysms. A 62-year-old woman presented with a large aneurysm on the right side of the cavernoussinus with dizziness for about two years and Oculomot or nerve palsy. An extra cranial intracranial (EC-IC) Intermediate-flow by pass using a radial artery bypass graft (RABG) and proximal balloon occlusion of the Right ICA were performed. The patient experienced no new neurologic deficit after this treatment. Follow up radiologic evaluations using Computed Tomography Angiography revealed complete aneurysm occlusion. For patients with large-giant CS ICA aneurysms, treatment of ICA occlusion combined with Intermediate-flow superficial temporal artery-Radial artery-middle cerebralartery bypass surgery was an effective and safe surgical strategy.

scholarly journals Spontaneous resolution of a tentorial dural arteriovenous fistula fed by the artery of Wollschlaeger and Wollschlaeger after embolization of the main shunting point

2021 ◽  
Vol 12 ◽  
pp. 413
Author(s):  
Ryota Ishibashi ◽  
Yoshinori Maki ◽  
Hiroyuki Ikeda ◽  
Masaki Chin
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Lesion ◽  
Endovascular Embolization ◽  
Vascular Events ◽  
Residual Shunt ◽  
Inferior Surface ◽  
Type Iii ◽  
Meningeal Arteries ◽  
The Right

Background: Tentorial dural arteriovenous fistula (TDAVF) is a rare intracranial vascular shunt. A TDAVF can be supplied by the Artery of Wollschlaeger and Wollschlaeger (AWW). However, a limited number of cases of TDAVF fed by the AWW have been reported to date. Case Description: A 70-year-old woman complaining of the right motor weakness underwent magnetic resonance imaging. A vascular lesion beneath the cerebellar tentorium was incidentally found with chronic infarction of the left corona radiata. Angiographically, the vascular lesion was a TDAVF supplied by the bilateral posterior meningeal arteries. No other apparent feeders were detected. The TDAVF had a shunting point on the inferior surface of the cerebellar tentorium with venous retrograde flow (Borden type III, Cognard type III). To prevent vascular events, endovascular embolization was performed using n-butyl-2-cyanoacrylate. Following embolization of the shunting point, a residual shunt fed by the AWW was identified. The shunt supplied by the AWW was not observed preoperatively. Follow-up angiography performed 1 week later revealed spontaneous disappearance of the residual shunt. The patient was followed-up in our outpatient clinic, and no recurrence of the TDAVF was confirmed postoperatively. Conclusion: Detection of mild feeding from the AWW to a TDAVF can be elusive preoperatively. Following embolization of the main shunting point, residual shunting from the AWW can resolve spontaneously.

scholarly journals A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

2021 ◽  
Vol 12 ◽  
pp. 594
Author(s):  
Hiromu Sunada ◽  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Hiroyuki Nakase ◽  
Hideyuki Ohnishi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Shunt Occlusion ◽  
Paradoxical Worsening ◽  
The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

scholarly journals Spinal Arteriovenous Fistula, A Manifestation of Hereditary Hemorrhagic Telangiectasia: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 417-420
Author(s):  
Jodi Spangler ◽  
Bjorn Watsjold ◽  
Jonathan Ilgen
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Early Recognition ◽  
Endovascular Embolization ◽  
High Morbidity ◽  
Autosomal Dominant Disorder ◽  
Arteriovenous Fistulas ◽  
Spinal Arteriovenous Fistula ◽  
The Right

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by arteriovenous malformations (AVM). HHT can have neurological manifestations. Case Report: A 32-year-old woman with a history of HHT presented to the emergency department with acute partial paralysis of the right leg, urinary retention, and right-sided back and hip pain. Magnetic resonance imaging of the spine demonstrated multiple, dilated blood vessels along the cervical spine, diffuse AVMs in the lumbar and thoracic spine, and a new arteriovenous fistula at the twelfth thoracic (T12) vertebral level. Her symptoms improved after endovascular embolization of the fistula. Conclusion: Spinal AVMs are thought to be more prevalent in patients with HHT. Given the high morbidity of arteriovenous fistulas, early recognition and intervention are critical.

scholarly journals Transvenous Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 85-92 ◽  
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
N. Tomura ◽  
J. Watarai ◽  
K. Mizoi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Gadopentetate Dimeglumine ◽  
Venous Access ◽  
Transvenous Embolization ◽  
Mr Images ◽  
Transfemoral Approach ◽  
Posterior Portion ◽  
Contrast Enhanced

We reviewed magnetic resonance (MR) images and digital subtraction angiograms (DSA) from eight patients with dural arteriovenous fistula of the cavernous sinus (DAVFCS) to clarify the fistulous points and to evaluate the venous access routes into the cavernous sinus for transvenous embolization (TVE). Multiplanar reconstruction of the MR images was achieved using three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) after the intravenous administration of gadopentetate dimeglumine (Gd-DTPA). TVE was performed using microcoils via the inferior petrosal sinus (IPS) using the transfemoral approach in five patients, via the facial vein and superior ophthalmic vein (SOV) using the transfemoral approach in 1 patient, and by SOV puncture in two patients. Most fistulas were detected in the posterior portion of the cavernous sinus or in the posterior intercavernous sinus in all of the patients. Fistulas identified as hyperintense dots or lines on contrast-enhanced 3-D fast SPGR images and were replaced with the microcoils. Target embolization of the fistulas was feasible in three patients treated via the SOV and in one patient treated via the IPS. Contrast-enhanced 3-D fast SPGR can help to identify the fistulous points of DAVFCS. Precise identification of fistulous points and selection of the adequate access route are mandatory for efficient TVE of DAVFCS.

scholarly journals Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Atsushi Tsukada ◽  
Kiyoyuki Yanaka ◽  
Kazuhiro Nakamura ◽  
Nobuyuki Takahashi ◽  
Kuniyuki Onuma ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Spontaneous Regression ◽  
Dural Arteriovenous Fistula ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Illustrative Case ◽  
Vascular Structure ◽  
The Right

BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.

scholarly journals Cavernous Sinus Dural Arteriovenous Fistula in a Patient with Thyroid-Associated Ophthalmopathy: Complete Resolution after Medical Treatment

2021 ◽  
Vol 12 (1) ◽  
pp. 45
Author(s):  
Nicola Cavasin ◽  
Fabio Presotto ◽  
Matteo Bellamio ◽  
Enrico Cagliari
Keyword(s):  
Cavernous Sinus ◽  
Medical Therapy ◽  
Complete Resolution ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Endovascular Embolization ◽  
External Carotid ◽  
First Line ◽  
Ocular Symptoms ◽  
Thyroid Associated Ophthalmopathy

Thyroid-associated ophthalmopathy (TAO) is a well-known and frequent epiphenomenon of a hyperthyroid autoimmune disease that can present with proptosis, strabismus, and diplopia. Ophthalmopathy can occur in the absence of overt Graves’ disease, even in euthyroid patients. Cavernous sinus dural fistulas (CS-DAVF) are abnormal communications between the cavernous sinus (CS) and dural branches from internal carotid or external carotid arteries. They can often present with ocular symptoms that can mimic a thyroid-associated ophthalmopathy. CS-DAVF are usually successfully treated with an endovascular embolization that can be pursued both through a transvenous or transarterial approach. TAO and CS-DAVF can coexist especially when the ocular symptoms are unilateral. In those cases, an endovascular embolization is usually curative, but sometimes the procedure can fail. Our hypothesis is that some cases of CS-DAVF may be of secondary nature (i.e., caused by compression of the venous outlet by the hypertrophic ocular muscles); therefore, treating the ocular disease with medical therapy may solve the vascular problem as well. We present a case of a CS-DAVF in a patient with TAO successfully treated with sole medical therapy after the failure of a first-line endovascular treatment.

scholarly journals Septic cavernous sinus thrombosis in a paediatric patient with undiagnosed thrombophilia

2019 ◽  
Vol 12 (10) ◽  
pp. e230159 ◽  
Author(s):  
Shafee Salloum ◽  
Joseph Bowens ◽  
Jordan Wright ◽  
Elizabeth Ey
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Epidural Abscess ◽  
Superior Sagittal Sinus ◽  
Anticoagulation Therapy ◽  
Factor V Leiden ◽  
Sagittal Sinus ◽  
Contrast Enhanced

A previously healthy 8-year-old girl presented to the hospital with right periorbital and forehead swelling in the setting of a 1-week history of upper respiratory symptoms. Contrast-enhanced CT revealed pansinusitis with orbital and frontal abscesses and thrombosis of the anterior portion of the superior sagittal sinus. She was treated with surgical drainage, antibiotics and anticoagulants. After 2 days she developed cranial nerve (CN) VI palsy. Contrast-enhanced MRI revealed small epidural abscess, right-sided thrombi of the cavernous sinus, internal carotid artery and internal jugular vein, in addition to the superior sagittal sinus. Thrombophilia workup revealed heterozygosity for factor V Leiden. She underwent 6 weeks of parental antibiotic therapy, 3 months of anticoagulation therapy and 7 days of steroids. With treatment, her visual acuity returned to baseline, CN VI palsy resolved and repeat imaging showed resolution of thrombi and epidural abscess, but persistent narrowing of the internal carotid artery.

scholarly journals Transvenous embolization of dural carotid cavernous fistula through the facial and ophthalmic vein

2011 ◽  
Vol 68 (12) ◽  
pp. 1079-1083 ◽  
Author(s):  
Branko Prstojevic ◽  
Mirko Micovic ◽  
Ivan Vukasinovic ◽  
Mirjana Nagulic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Right ◽  
Transvenous Approach

Introduction. Dural carotid cavernous fistula is acquired, relatively rare, condition comprising of numerous smallcaliber meningeal arterial branches, draining directly into cavernous sinus. Endovascular therapy is the treatment of choice, preferably by a transvenous approach. In the case of inaccessible inferior petrosal sinus, other alternative routes are considered. We presented a case of dural carotid cavernous fistula completely occluded with Guglielmi detachable coils, using a transvenous approach through facial and superior ophthalmic vein. Case report. A 62-year-old man was referred with a gradual worsening proptosis, red eye, and decreased visual acuity, on the right side. Digital subtraction angiography revealed the presence of a right dural carotid cavernous fistula, predominantly supplied from dural branches of the right internal carotid artery siphon, with minimal contribution from the right middle meningeal artery and contralateral dural branches of the left internal carotid artery siphon. The fistula was drainaged through the dilated superior ophthalmic vein, and via the facial to the internal jugular vein. There was neither pacification of pterygoid and petrous sinuses, nor cortical venous reflux. Endovascular treatment was performed by a transvenous approach. A guiding catheter was placed in the right facial vein. A microcatheter was advanced through the dilated angular and superior ophthalmic vein, and its tip positioned into the right cavernous sinus. Coils were deployed, until a complete angiographic occlusion of the fistula had been achieved. The patient experienced rapid improvement in the symptoms, with complete normalization of his condition one month after the treatment. Conclusion. Coil embolization of dural carotid cavernous fistula by transvenous catheterization, through the facial and superior ophthalmic vein, can be considered as safe and effective treatment option in the presence of marked anterior drainage.

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