An innovative technique for detecting the caudal end of occluded inferior petrosal sinus in cavernous arteriovenous fistula using intravascular ultrasonography—technical note

Shigeru Yamauchi,Yoshinobu Takahashi,Taichiro Kawakami,Kenji Ohata,Yutaka Mitsuhashi,Akimasa Nishio,Yuzo Terakawa,Kimito Kondo

doi:10.1007/s00234-015-1530-8

Shigeru Yamauchi, Yoshinobu Takahashi + Show 6 more

Open Access

https://doi.org/10.1007/s00234-015-1530-8

Copy DOI

Abstract

IntroductionAlthough cavernous sinus (CS) dural arteriovenous fistulas (d-AVFs) are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible. In such cases, the first obstacle to TVE is detecting the entry to the IPS. We report a new technique for TVE via IPS using intravascular ultrasonography (IVUS).MethodsThree consecutive cases of CS d-AVF with ipsilateral or bilateral IPS occlusion were involved in this study. On TVE, the orifice of the IPS was investigated with IVUS placed in the jugular vein or jugular bulb.ResultsThis technique has been successfully adapted in all three cases. In two of these cases, IPS was well visualized with the help of IVUS, and TVE was successfully performed.ConclusionTo our knowledge, this is the first report to mention the usefulness of IVUS for detecting angiographically occult IPS.

Highlights

Cavernous sinus (CS) dural arteriovenous fistulas (d-AVFs) are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible
cavernous sinus (CS) d-AVFs are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible
We describe the usefulness of intravascular ultrasonography (IVUS) for detecting an angiographically invisible caudal end of the IPS

Summary

Introduction

Cavernous sinus (CS) dural arteriovenous fistulas (d-AVFs) are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible. In such cases, the first obstacle to TVE is detecting the entry to the IPS. CS d-AVFs are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible In such cases, the first obstacle to TVE is detecting the entry to the IPS, and this can prove difficult due to angiographic invisibility and anatomical variations. We describe the usefulness of intravascular ultrasonography (IVUS) for detecting an angiographically invisible caudal end of the IPS

Objectives

Methods

Results

Discussion

Conclusion