Article

Transvenous embolization of a dural arteriovenous fistula of the laterocavernous sinus through the pterygoid plexus.

Division of Interventional Neuroradiology, Johns Hopkins Hospital, 600 North Wolfe Street, B-100, Baltimore, MD 21287, USA.
Neuroradiology (Impact Factor: 2.7). 09/2007; 49(8):665-8. DOI: 10.1007/s00234-007-0245-x
Source: PubMed

ABSTRACT We present a novel access for transvenous embolization of a dural arteriovenous fistula of the laterocavernous sinus through the external jugular vein and the pterygoid plexus. The anatomy of the laterocavernous sinus is reviewed, and its clinical implications discussed in light of the case of a patient whose management was modified after identifying this anatomical variation.

0 Bookmarks
 · 
68 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report our findings concerning the laterocavernous sinus (LCS) drainage of dural fistulas, focusing our attention on the important implications in treatment of the LCS, which is one of the principal drainage pathways of the superficial middle cerebral vein (SMCV). Consecutive 32 patients with dural fistulas treated endovascularly between 2005 and 2008 were reviewed. Seven patients had angiographic features such as dural fistulas draining with SMCV via LCS. Clinical records for these 7 patients were focused to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Over 3 years, 7 patients had 7 dural fistulas drained with SMCV via LCS were treated. Six-vessel angiography confirmed the presence of the dural fistulas. All fistulas were Cognard Type III featured by leptomeningeal veins drainage. One fistula involving the lesser sphenoid wing and 6 fistulas involving CS were supplied by external carotid artery branches with or without dural branches of the internal carotid artery. LCS was identified as a contiguous to SMCV drainage in these cases. One patient was treated with transvenous coil embolization alone, two with transvenous a combination of Onyx and coil embolization, and 4 with transarterial embolization. An angiographic obliteration and clinical cure was achieved in all patients. Complication was local hair loss due to X-ray radiation in one patient. It is very important to diagnose the presence of LCS in dural fistulas during the diagnostic angiography. It is believed that the knowledge of LCS might be relevant for the understanding and treatment of dural fistulas involving the LCS.
    European journal of radiology 02/2010; 75(2):e129-34. · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The laterocavernous sinus system is best defined as the entire territory served by the laterocavernous and the superior petrosal sinuses (SPS). The laterocavernous sinus is a small but important venous structure located between the two dural layers forming the lateral wall of the cavernous sinus and has been described as one of the principal drainage pathways of the deep and superficial middle cerebral veins. Several disease processes in the head involve the laterocavernous sinus. To evaluate and treat these diseases it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the laterocavernous sinus and venous watershed between the deep and superficial venous systems. In the present report the normal angiographic anatomy of the laterocavernous sinus system, its relationship with the deep and superficial venous systems, and its importance in clinical situations are outlined.
    World Neurosurgery 01/2011; 75(1):90-3; discussion 34-5. · 1.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe the technique, efficacy, and safety of transvenous embolisation (TVE) of cavernous sinus arteriovenous fistulas (CSDAVFs) via the inferior petrosal sinus (IPS) with detachable coils and acrylic glue. Spontaneous unilateral CSDAVFs were confirmed by cerebral angiography in eight patients, with angiographic patency of the ipsilateral IPS in three and angiographic non-visualisation of the ipsilateral IPS in five. There were two patients with complete occlusion of the ipsilateral internal jugular vein (IJV). TVE with detachable coils and acrylic glue were performed through a femoral vein and an IPS approach. TVE viaipsilateral IPS was successfully performed in all eight patients in our group. The number of detachable coils for each patient ranged from 2 to 8 (mean, 5.0). Angiography immediately after TVE showed complete occlusion of the CSCAVFs in seven patients and nearly complete occlusion in one. Complete recovery of clinical symptoms was achieved in all eight patients. No recurrence of clinical symptoms was observed at follow-up. Transvenous embolisation via an IPS approach is a highly efficient and safe treatment for CSDAVFs. Embolisation with a combination of coils and acrylic glue may help to achieve complete occlusion of fistulas with fewer coils.
    European Radiology 12/2010; 20(12):2939-47. · 4.34 Impact Factor