Transcortical Venous Approach for Direct Embolization of a.Cavernous Sinus Dural Arteriovenous Fistula: Technical Case Report

摘要

Dural arteriovenous fistuias (dAVFs) represent 10% to 15% of all in-tracranial arteriovenous maiformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which emboHzation of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein. CUBICAL 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 menlngohypophyseal trunk. Percutaneous transvenous access failed, and only partial oc-clusicn was achieved by transarterial embolization. A frontotempcra! craniotomy was performed to access the superficial middle cerebral vein in the left syivian 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 occiusion. This transcrsnial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarteriai or transvenous approaches fail or are not possible.