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Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report.
Neurosurgery. 2011 Aug; 69(2):E475-81; discussion E481-2.N

Abstract

BACKGROUND AND IMPORTANCE

High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option.

CLINICAL PRESENTATION

We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery.

CONCLUSION

This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

Authors+Show Affiliations

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21792142

Citation

Hurley, Michael C., et al. "Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-grade Cavernous Dural Arteriovenous Fistula: Case Report." Neurosurgery, vol. 69, no. 2, 2011, pp. E475-81; discussion E481-2.
Hurley MC, Rahme RJ, Fishman AJ, et al. Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report. Neurosurgery. 2011;69(2):E475-81; discussion E481-2.
Hurley, M. C., Rahme, R. J., Fishman, A. J., Batjer, H. H., & Bendok, B. R. (2011). Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report. Neurosurgery, 69(2), E475-81; discussion E481-2. https://doi.org/10.1227/NEU.0b013e3182192478
Hurley MC, et al. Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-grade Cavernous Dural Arteriovenous Fistula: Case Report. Neurosurgery. 2011;69(2):E475-81; discussion E481-2. PubMed PMID: 21792142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report. AU - Hurley,Michael C, AU - Rahme,Rudy J, AU - Fishman,Andrew J, AU - Batjer,H Hunt, AU - Bendok,Bernard R, PY - 2011/7/28/entrez PY - 2011/7/28/pubmed PY - 2012/2/7/medline SP - E475-81; discussion E481-2 JF - Neurosurgery JO - Neurosurgery VL - 69 IS - 2 N2 - BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21792142/Combined_surgical_and_endovascular_access_of_the_superficial_middle_cerebral_vein_to_occlude_a_high_grade_cavernous_dural_arteriovenous_fistula:_case_report_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e3182192478 DB - PRIME DP - Unbound Medicine ER -