Percutaneous transfemoral embolization of an indirect carotid—cavernous fistula with cortical venous access to the cavernous sinus

Case report

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✓ The authors present the case of a 61-year-old man with an indirect carotid—cavernous fistula (CCF). Many now advocate a primary transvenous approach to deal with such lesions, with packing and thrombosis of the cavernous sinus leading to fistula obliteration. Transvenous access to the cavernous sinus via the inferior petrosal sinus is the usual route of access; both surgical and transfemoral superior ophthalmic vein approaches are also well described. In the case presented, the anatomy of the CCF was unfavorable for these approaches and its dominant venous egress was via a single enlarged arterialized cortical vein. The cavernous sinus was accessed with a transfemoral retrograde approach to the cortical draining vein. Successful CCF embolization was documented radiographically and clinically. To the authors' knowledge, this procedure has not been previously described in the English literature.

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Contributor Notes

Address reprint requests to: Richard J. Bellon, M.D., Department of Neuroradiology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, California 94305–5105. email: Rbellon@worldnet.att.net

© AANS, except where prohibited by US copyright law.

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References
  • 1.

    Awad IALittle JRAkrawi WPet al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:8398501990Awad IA Little JR Akrawi WP et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Croft HJKallmes DFJensen MEet al: Percutaneous transvenous coil embolization of a Type 4 sagittal sinus dural arteriovenous fistula: case report. Neurosurgery 41:119111941997Croft HJ Kallmes DF Jensen ME et al: Percutaneous transvenous coil embolization of a Type 4 sagittal sinus dural arteriovenous fistula: case report. Neurosurgery 41:1191–1194 1997

    • Search Google Scholar
    • Export Citation
  • 3.

    Dawson RC IIIJoseph GJOwens DSet al: Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR 19:5715761998Dawson RC III Joseph GJ Owens DS et al: Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR 19:571–576 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Day JDFukushima T: Direct microsurgery of dural arteriovenous malformation type carotid-cavernous sinus fistulas: indications, technique, and results. Neurosurgery 41:111911261997Day JD Fukushima T: Direct microsurgery of dural arteriovenous malformation type carotid-cavernous sinus fistulas: indications technique and results. Neurosurgery 41:1119–1126 1997

    • Search Google Scholar
    • Export Citation
  • 5.

    Halbach VVHigashida RTHieshima GBet al: Treatment of dural fistulas involving the deep cerebral venous system. AJNR 10:3933991989Halbach VV Higashida RT Hieshima GB et al: Treatment of dural fistulas involving the deep cerebral venous system. AJNR 10:393–399 1989

    • Search Google Scholar
    • Export Citation
  • 6.

    Higashida RTHieshima GBHalbach VVet al: Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl 369:5805831986Higashida RT Hieshima GB Halbach VV et al: Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl 369:580–583 1986

    • Search Google Scholar
    • Export Citation
  • 7.

    Jahan RGobin YPGlenn Bet al: Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus. Neuroradiology 40:1891931998Jahan R Gobin YP Glenn B et al: Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus. Neuroradiology 40:189–193 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Kallmes DFJensen MECloft HJet al: Percutaneous transvenous coil embolization of a Djindjian type 4 tentorial dural arteriovenous malformation. AJNR 18:6736761997Kallmes DF Jensen ME Cloft HJ et al: Percutaneous transvenous coil embolization of a Djindjian type 4 tentorial dural arteriovenous malformation. AJNR 18:673–676 1997

    • Search Google Scholar
    • Export Citation
  • 9.

    Kuwayama NEndo SKitabayashi Met al: Surgical transvenous embolization of a cortically draining carotid cavernous fistula via a vein of the sylvian fissure. AJNR 19:132913321998Kuwayama N Endo S Kitabayashi M et al: Surgical transvenous embolization of a cortically draining carotid cavernous fistula via a vein of the sylvian fissure. AJNR 19:1329–1332 1998

    • Search Google Scholar
    • Export Citation
  • 10.

    Lucas CPZabramski JMSpetzler RFet al: Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 40:111911321997Lucas CP Zabramski JM Spetzler RF et al: Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 40:1119–1132 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Miller DLDoppman JL: Petrosal sinus sampling: technique and rationale. Radiology 178:37471991Miller DL Doppman JL: Petrosal sinus sampling: technique and rationale. Radiology 178:37–47 1991

    • Search Google Scholar
    • Export Citation
  • 12.

    Miller NRMonsein LHDebrun GMet al: Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83:8388421995Miller NR Monsein LH Debrun GM et al: Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83:838–842 1995

    • Search Google Scholar
    • Export Citation
  • 13.

    Mironov A: Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR 19:3893911998Mironov A: Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR 19:389–391 1998

    • Search Google Scholar
    • Export Citation
  • 14.

    Quinones DDuckwiler GGobin YPet al: Embolization of dural cavernous fistulas via superior ophthalmic vein approach. AJNR 18:9219281997Quinones D Duckwiler G Gobin YP et al: Embolization of dural cavernous fistulas via superior ophthalmic vein approach. AJNR 18:921–928 1997

    • Search Google Scholar
    • Export Citation
  • 15.

    Roy DRaymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:113311441997Roy D Raymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:1133–1 144 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Tu YKLiu HMHu SC: Direct surgery of carotid cavernous fistulae and dural arteriovenous malformations of the cavernous sinus. Neurosurgery 41:7988061997Tu YK Liu HM Hu SC: Direct surgery of carotid cavernous fistulae and dural arteriovenous malformations of the cavernous sinus. Neurosurgery 41:798–806 1997

    • Search Google Scholar
    • Export Citation
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