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Transorbital Cavernous Sinus Direct Puncture : Alternative to treat dural arteriovenous fistula.
Clin Neuroradiol. 2018 Mar; 28(1):55-61.CN

Abstract

INTRODUCTION

The authors present a retrospective series of their clinical experience in the treatment of cavernous dural arteriovenous fistulas (DAVF) by direct transorbital puncture of the cavernous sinus as an alternative to the endovascular approach.

METHODS

Between October 2012 and September 2014, eight patients harboring cavernous DAVF underwent percutaneous treatment by direct transorbital puncture of the cavernous sinus at three institutions. All patients presented with ocular symptoms. Standard endovascular approaches, including transvenous and transarterial routes, were primarily attempted without success in all cases. Direct puncture was performed through two different approaches, namely inferolateral and superomedial. The entry point was the inferior and superior eyelid, respectively. Embolization was performed with coils or Onyx (Covidien, Irvine, CA). Immediate and late angiographies were used to evaluate the occlusion of the fistula.

RESULTS

Of the patients seven had complete occlusion of the cavernous DAVFs noted on the immediate and follow-up angiograms and one patient had residual filling but reduction of the shunt resulted in clinical improvement. None of the patients had worsening of neurological function. One case was complicated by inadvertent internal carotid puncture but without clinical manifestations. One patient experienced postoperative superior ophthalmic vein thrombosis.

CONCLUSION

In very specific cases, when endovascular access is not possible or fails to occlude cavernous DAVF, direct transorbital puncture of the cavernous sinus was shown to be feasible, safe and very effective.

Authors+Show Affiliations

Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil. felipepadovani@yahoo.com.br.Serviço de Neurologia e Neurocirurgia, Passo Fundo, Rio Grande do Sul, Brazil.Serviço de Neurologia e Neurocirurgia, Passo Fundo, Rio Grande do Sul, Brazil.Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil.Serviço de Neurologia e Neurocirurgia, Passo Fundo, Rio Grande do Sul, Brazil.Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27506673

Citation

Trivelato, Felipe Padovani, et al. "Transorbital Cavernous Sinus Direct Puncture : Alternative to Treat Dural Arteriovenous Fistula." Clinical Neuroradiology, vol. 28, no. 1, 2018, pp. 55-61.
Trivelato FP, Manzato LB, Filho PMM, et al. Transorbital Cavernous Sinus Direct Puncture : Alternative to treat dural arteriovenous fistula. Clin Neuroradiol. 2018;28(1):55-61.
Trivelato, F. P., Manzato, L. B., Filho, P. M. M., Ulhôa, A. C., Vanzin, J. R., Abud, D. G., & Rezende, M. T. S. (2018). Transorbital Cavernous Sinus Direct Puncture : Alternative to treat dural arteriovenous fistula. Clinical Neuroradiology, 28(1), 55-61. https://doi.org/10.1007/s00062-016-0534-z
Trivelato FP, et al. Transorbital Cavernous Sinus Direct Puncture : Alternative to Treat Dural Arteriovenous Fistula. Clin Neuroradiol. 2018;28(1):55-61. PubMed PMID: 27506673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transorbital Cavernous Sinus Direct Puncture : Alternative to treat dural arteriovenous fistula. AU - Trivelato,Felipe Padovani, AU - Manzato,Luciano Bambini, AU - Filho,Paulo Moacir Mesquita, AU - Ulhôa,Alexandre Cordeiro, AU - Vanzin,José Ricardo, AU - Abud,Daniel Giansante, AU - Rezende,Marco Túlio Salles, Y1 - 2016/08/09/ PY - 2016/05/31/received PY - 2016/07/15/accepted PY - 2016/8/11/pubmed PY - 2018/12/18/medline PY - 2016/8/11/entrez KW - Cavernous sinus KW - Dural arteriovenous fistula KW - Embolization KW - Endovascular SP - 55 EP - 61 JF - Clinical neuroradiology JO - Clin Neuroradiol VL - 28 IS - 1 N2 - INTRODUCTION: The authors present a retrospective series of their clinical experience in the treatment of cavernous dural arteriovenous fistulas (DAVF) by direct transorbital puncture of the cavernous sinus as an alternative to the endovascular approach. METHODS: Between October 2012 and September 2014, eight patients harboring cavernous DAVF underwent percutaneous treatment by direct transorbital puncture of the cavernous sinus at three institutions. All patients presented with ocular symptoms. Standard endovascular approaches, including transvenous and transarterial routes, were primarily attempted without success in all cases. Direct puncture was performed through two different approaches, namely inferolateral and superomedial. The entry point was the inferior and superior eyelid, respectively. Embolization was performed with coils or Onyx (Covidien, Irvine, CA). Immediate and late angiographies were used to evaluate the occlusion of the fistula. RESULTS: Of the patients seven had complete occlusion of the cavernous DAVFs noted on the immediate and follow-up angiograms and one patient had residual filling but reduction of the shunt resulted in clinical improvement. None of the patients had worsening of neurological function. One case was complicated by inadvertent internal carotid puncture but without clinical manifestations. One patient experienced postoperative superior ophthalmic vein thrombosis. CONCLUSION: In very specific cases, when endovascular access is not possible or fails to occlude cavernous DAVF, direct transorbital puncture of the cavernous sinus was shown to be feasible, safe and very effective. SN - 1869-1447 UR - https://www.unboundmedicine.com/medline/citation/27506673/Transorbital_Cavernous_Sinus_Direct_Puncture_:_Alternative_to_treat_dural_arteriovenous_fistula_ L2 - https://dx.doi.org/10.1007/s00062-016-0534-z DB - PRIME DP - Unbound Medicine ER -