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Transcortical venous approach for direct embolization of a cavernous sinus dural arteriovenous fistula: technical case report.
Neurosurgery. 2012 Jun; 70(2 Suppl Operative):343-8.N

Abstract

BACKGROUND AND IMPORTANCE

Dural arteriovenous fistulas (dAVFs) represent 10% to 15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein.

CLINICAL PRESENTATION

An 82-year-old woman presented with diplopia, left sixth cranial nerve palsy, intraocular hypertension, and bilateral chemosis. Angiography revealed a complex cavernous dAVF with cortical venous reflux, supplied by both external carotid arteries and the left meningohypophyseal trunk. Percutaneous transvenous access failed, and only partial occlusion was achieved by transarterial embolization. A frontotemporal craniotomy was performed to access the superficial middle cerebral vein in the left sylvian fissure. Under fluoroscopic guidance, a microcatheter was advanced through this vein to the floor of the middle cranial fossa and into the dAVF, permitting coil occlusion.

CONCLUSION

This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible.

Authors+Show Affiliations

Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada. nchaudh3@uwo.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22072128

Citation

Chaudhary, Navjot, et al. "Transcortical Venous Approach for Direct Embolization of a Cavernous Sinus Dural Arteriovenous Fistula: Technical Case Report." Neurosurgery, vol. 70, no. 2 Suppl Operative, 2012, pp. 343-8.
Chaudhary N, Lownie SP, Bussière M, et al. Transcortical venous approach for direct embolization of a cavernous sinus dural arteriovenous fistula: technical case report. Neurosurgery. 2012;70(2 Suppl Operative):343-8.
Chaudhary, N., Lownie, S. P., Bussière, M., Pelz, D. M., & Nicolle, D. (2012). Transcortical venous approach for direct embolization of a cavernous sinus dural arteriovenous fistula: technical case report. Neurosurgery, 70(2 Suppl Operative), 343-8. https://doi.org/10.1227/NEU.0b013e31823fcc6e
Chaudhary N, et al. Transcortical Venous Approach for Direct Embolization of a Cavernous Sinus Dural Arteriovenous Fistula: Technical Case Report. Neurosurgery. 2012;70(2 Suppl Operative):343-8. PubMed PMID: 22072128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcortical venous approach for direct embolization of a cavernous sinus dural arteriovenous fistula: technical case report. AU - Chaudhary,Navjot, AU - Lownie,Stephen P, AU - Bussière,Miguel, AU - Pelz,David M, AU - Nicolle,David, PY - 2011/11/11/entrez PY - 2011/11/11/pubmed PY - 2013/2/19/medline SP - 343 EP - 8 JF - Neurosurgery JO - Neurosurgery VL - 70 IS - 2 Suppl Operative N2 - BACKGROUND AND IMPORTANCE: Dural arteriovenous fistulas (dAVFs) represent 10% to 15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein. CLINICAL PRESENTATION: An 82-year-old woman presented with diplopia, left sixth cranial nerve palsy, intraocular hypertension, and bilateral chemosis. Angiography revealed a complex cavernous dAVF with cortical venous reflux, supplied by both external carotid arteries and the left meningohypophyseal trunk. Percutaneous transvenous access failed, and only partial occlusion was achieved by transarterial embolization. A frontotemporal craniotomy was performed to access the superficial middle cerebral vein in the left sylvian fissure. Under fluoroscopic guidance, a microcatheter was advanced through this vein to the floor of the middle cranial fossa and into the dAVF, permitting coil occlusion. CONCLUSION: This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/22072128/Transcortical_venous_approach_for_direct_embolization_of_a_cavernous_sinus_dural_arteriovenous_fistula:_technical_case_report_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e31823fcc6e DB - PRIME DP - Unbound Medicine ER -