Superior petrosal sinus catheterization for transvenous embolization of a dural carotid cavernous sinus fistula

Abstract

We report the endovascular treatment of a dural carotid cavernous fistula in a 67-year-old woman in whom superior petrosal sinus catheterization was performed to access the venous site of the fistula. To our knowledge, this retrograde venous route via the superior petrosal sinus has not been previously described.

Fig 1.

Lateral angiograms. A, Arterial-phase right internal carotid arteriogram shows the DCCF at the right posterosuperior aspect of the CS (solid arrow) fed by dural branches of the carotid siphon. The right trigeminal vein (open arrow) is draining the DCCF. B, Right external carotid arteriogram shows that the DCCF is draining into the right superficial middle cerebral vein (arrowheads), the right SOV (solid arrow), and the right trigeminal vein (open arrow).

Fig 2.

Venous-phase lateral left common carotid arteriogram. The most distal aspect of the right SPS is faintly opacified as it merges with the right transverse sinus (arrow)

Fig 3.

Frontal skull radiographic image shows retrograde catheterization of the right SPS via a right internal jugular route. A 5F hydrophilic catheter (arrow) is positioned into the distal end of the right SPS by means of a right jugular approach. A microcatheter (arrowhead) is coaxially introduced into the 5F catheter and navigated into the SPS to reach the CS

Fig 4.

Right common carotid control angiogram obtained at the end of the embolization procedure shows that the DCCF is no more opacified than before and during the procedure.