Transvenous Embolization of Cavernous and Paracavernous Dural Arteriovenous Fistula through the Facial Vein: Report of 12 Cases

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Abstract

Purpose

The aim of this study was to evaluate the feasibility and safety of the transfacial venous embolization of cavernous or paracavernous dural arteriovenous fistula (DAVF) in which approach via inferior petrosal sinus (IPS) was not feasible.

Materials and Methods

We identified the cases of transfacial venous embolization of cavernous sinus (CS) or adjacent dural sinuses from the neurointerventional database of three hospitals. The causes and clinical and angiographic outcomes of transfacial venous embolization were retrospectively evaluated.

Results

Twelve patients with CS (n = 11) or lesser wing of sphenoid sinus (LWSS, n = 1) DAVF were attempted to treat by transvenous embolization via ipsilateral (n = 10) or contralateral (n = 2) facial vein. Trans-IPS access to the target lesion was impossible due to chronic occlusion (n = 11) or acute angulation adjacent the target lesion (n = 1). In all twelve cases, it was possible to navigate through facial vein, angular vein, superior ophthalmic vein, and then CS. It was also possible to further navigation to contralateral CS through intercavernous sinus in two cases, and laterally into LWSS in one case. Post-treatment control angiography revealed complete occlusion of the DAVF in eleven cases and partial occlusion in one patient, resulting in complete resolution of presenting symptom in eight and gradually clinical improvement in four patients. There was no treatment-related complication during or after the procedure.

Conclusion

In the cavernous or paracavernous DAVF in which trans-IPS approach is not feasible, the facial vein seems to be safe and effective alternative route for transvenous embolization.

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Most cited references 20

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Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up.

Philip M Meyers, Van V. Halbach, Christopher Dowd … (2002)

To describe the endovascular treatment and clinical outcome in patients with indirect carotid cavernous fistulas (CCFs) over a 15-year period. To our knowledge, this is the largest series in the medical literature. Interventional case series. A retrospective evaluation of 135 consecutive patients who underwent examination and treatment for indirect CCF was performed. Patients received independent evaluations by ophthalmologists, neurologists, or neuro-ophthalmologists before, during, and after endovascular treatment. Patients initially received noninvasive imaging followed by cerebral arteriography for definitive diagnosis and stratification by angiographic risk factors. Endovascular treatment was performed in 133 (98%) patients and clinical follow-up was achieved in 135 (100%) patients on an average of 56 +/- 4.3 months (range: 2 months-14 years). Angiographic follow-up was performed in 72 (54%) patients with ongoing symptoms or a history of fistula with high-risk angiographic features. Arteriographic cure with long-term clinical outcome is summarized by modified Rankin scale (mRS) and Barthel index (BI). At a mean follow-up of 56 months, 121 (90%) patients were clinically cured. At latest clinical follow-up, 131 (97%) patients showed good recovery (mRS, 1-2; BI 90-100), one (1%) had moderate disability (mRS, 3; BI, 50-60), and three (2%) (mRS, 4; BI, 40-50) were severely disabled. Procedure-related permanent morbidity was 2.3%. There was no operative mortality. With the observed favorable outcomes and low rate of procedural morbidity in this patient population with long-term angiographic and clinical follow-up, endovascular therapy should be the primary treatment for patients with indirect (dural) fistulas of the cavernous sinus.

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Cavernous sinus dural fistulae treated by transvenous approach through the facial vein: report of seven cases and review of the literature.

Alessandra Biondi, Dan Milea, Christophe Cognard … (2016)

Dural Carotid Cavernous Fistulas (CCFs) can be treated by transarterial and/or transvenous endovascular techniques. The venous route usually goes through the internal jugular vein (IJV) and the inferior petrosal sinus (IPS) up to the pathologic shunts of the cavernous sinus. In case a thrombosed IPS, catheterization through the obstructed sinus is not always possible and a puncture of the superior ophthalmic vein (SOV) can be performed often after a surgical approach. We report our results in the endovascular transvenous treatment of dural CCFs through the facial vein (retrograde catheterization of the IJV, facial vein, angular vein, SOV, and cavernous sinus). A retrospective study of seven patients with a dural CCF treated with transvenous embolization via the facial vein was performed. In five patients, the IPS was thrombosed. In one patient, the IPS was patent, but there was not communication between the cavernous sinus compartment in which the CCF shunts were located and the IPS itself. In the only patient with the CCF draining through permeable IPS, the transvenous route through the IPS permitted the occlusion of the posterior CCF shunts and a second session was performed through the facial vein in order to occlude the shunts of the anterior compartment of the cavernous sinus. The other six patients underwent one embolization session only. In all seven cases, it was possible to navigate through the tortuous junction of the angular vein and the SOV. In one patient with a thrombosed SOV, the venous procedure was interrupted because the catheterization through the occluded SOV failed. In the other six patients, after transvenous catheterization of the cavernous sinus via the facial vein, placement of coils resulted in complete occlusion of the dural CCF with clinical cure in four patients and improvement in two. In the endovascular treatment of the dural CCFs, the transfemoral approach via the facial vein provides a valuable alternative to other transvenous routes. Catheterization of the cavernous sinus via the facial vein is usually successful. Although this technique requires caution, it allows a safe and effective treatment of these lesions.

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Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management.

D J Kim, D I Kim, S Suh … (2015)

To describe the results of transvenous embolizations of cavernous dural arteriovenous fistua (cDAVF) with an emphasis on identifying the incidence, characteristics, and management strategies associated with the complications of transvenous embolization of cDAVFs. Fifty-six consecutive patients who were treated by transvenous embolization for cDAVFs were reviewed. The approach routes, angiographic results, complications, and clinical outcome were assessed. Retrograde inferior petrosal sinus (n = 36), transfacial vein (n = 7), transcontralateral intercavernous sinus (n = 4), and direct superior ophthalmic vein (n = 3) approaches were used. Angiographic results showed complete occlusion (n = 29), nearly complete occlusion (n = 13), and incomplete occlusion (n = 14). Complications associated with the procedures were cranial nerve palsy (n = 6), venous perforation (n = 3), and brain stem congestion (n = 2). The cranial nerve signs resolved with conservative treatment. Venous perforations were managed by coil embolizations at the site of the tear with no significant neurologic sequelae. One case of brain stem congestion resulted in hemiplegia after conservative treatment. The other case showed venous congestion as a result of rerouting of the shunted flow after venous embolization that was successfully managed by covered stent deployment for occlusion of the residual feeders. Clinical follow-up data were available in 46 patients. Complete resolution or improvement of symptoms was seen in 42 patients (91%). Cavernous DAVFs may be effectively treated by transvenous embolization. However, the procedure can be associated with various complications, some of which can potentially result in significant morbidity. Prompt diagnosis of the complications with appropriate management strategies is mandatory for a safe procedure.

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Author and article information

Journal

Journal ID (nlm-ta): Neurointervention

Journal ID (iso-abbrev): Neurointervention

Journal ID (publisher-id): NI

Title: Neurointervention

Publisher: Korean Society of Interventional Neuroradiology

ISSN (Print): 2093-9043

ISSN (Electronic): 2233-6273

Publication date (Print): February 2013

Publication date (Electronic): 28 February 2013

Volume: 8

Issue: 1

Pages: 15-22

Affiliations

[1 ]Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

[2 ]Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

[3 ]Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

[4 ]Department of Radiology, NHIC Ilsan Hospital of Korea, Ilsan, Korea.

[5 ]Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Author notes

Correspondence to: Bum-soo Kim, MD, PhD, Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel. 82.2.2258.6239, Fax. 82.2.599.6771, bumrad@ 123456catholic.ac.kr

Article

DOI: 10.5469/neuroint.2013.8.1.15

PMC ID: 3601275

PubMed ID: 23515272

SO-VID: 7e8dbae2-1960-4ba9-a9a9-88533c9e4e1c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Transvenous Embolization of Cavernous and Paracavernous Dural Arteriovenous Fistula through the Facial Vein: Report of 12 Cases

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Most cited references 20

Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up.

Cavernous sinus dural fistulae treated by transvenous approach through the facial vein: report of seven cases and review of the literature.

Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management.

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