Endovascular Approaches to the Cavernous Sinus in the Setting of Dural Arteriovenous Fistula.

Naoki Kaneko,Viktor Szeder,Robert Goldberg,Justin Dye,Gary Duckwiler,Nestor Gonzalez,Daniel Rootman,Satoshi Tateshima,Reza Jahan

doi:10.3390/brainsci10080554

Abstract

Dural arteriovenous fistulas involving the cavernous sinus can lead to orbital pain, vision loss and, in the setting of associated cortical venous reflux, intracranial hemorrhage. The treatment of dural arteriovenous fistulas has primarily become the role of the endovascular surgeon. The venous anatomy surrounding the cavernous sinus and venous sinus thrombosis that is often associated with these fistulas contributes to the complexity of these interventions. The current report gives a detailed description of the alternate endovascular routes to the cavernous sinus based on a single center’s experience as well as a literature review supporting each approach. A comprehensive understanding of the anatomy and approaches to the cavernous sinus available to the endovascular surgeon is vital to the successful treatment of this condition.

Highlights

The cavernous sinuses (CS) are dural venous channels located on either side of the body of the sphenoid bone
Disadvantage is the technical difficulty of traversing the tight net of vessels tight net of vessels that make up the pterygoid plexus, and it is generally reserved for cases that make up the pterygoid plexus, and it is generally reserved for cases of bilateral in petrosal sinus (IPS) and of bilateral
We have reported the treatment of a paracavernous venous plexus fistula with an with coils [28]

Summary

Introduction

The cavernous sinuses (CS) are dural venous channels located on either side of the body of the sphenoid bone. The medial wall, the only with a single layer of dura, makes up the lateral limit of the sella. The cavernous segment of the internal carotid artery (ICA) runs within the CS with CN VI running along its inferior and lateral border. Indirect carotid cavernous fistulas (dural CCF) are a type of dural arteriovenous fistula (DAVF) that occurs when an abnormal connection forms between the CS and meningeal branches of the external carotid artery (ECA), meningeal branches of the internal carotid artery (ICA), or the ICA itself. Direct CCFs can be treated through a transarterial approach with access to the CS across the tear in the cavernous segment of the carotid artery [3,6]. Secondary to multiple small arterial feeders, which may supply cranial nerves, dural CCFs are often treated with a transvenous approach to the CS followed by coil or liquid embolic embolization of the CS itself. The current report focuses on dural CCFs and the multiple transvenous routes to the CS available to the endovascular surgeon

Inferior Petrosal Sinus Via the Internal Jugular Vein

Superior

The superior ophthalmic

Superior Ophthalmic Vein Via the Middle Temporal Vein

Pterygoid

Inferior Petrooccipital Vein

Percutaneous Transorbital

10. Surgical drainage

11. Surgical Exposure of the Cavernous Sinus

Demonstrates

12. Transarterial Via

10. Demonstrates