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. 2013 Oct;26(5):565-72.
doi: 10.1177/197140091302600510. Epub 2013 Nov 7.

Endovascular occlusion of dural cavernous fistulas through a superior ophthalmic vein approach

Francesco Briganti  1 , Ferdinando Caranci, Giuseppe Leone, Manuela Napoli, Domenico Cicala, Giuseppe Briganti, Fausto Tranfa, Giulio Bonavolontà
Affiliations

Endovascular occlusion of dural cavernous fistulas through a superior ophthalmic vein approach

Francesco Briganti et al. Neuroradiol J. 2013 Oct.

Abstract

Dural cavernous fistulas are low-flow vascular malformations with usually benign clinical course and a high rate of spontaneous resolution. Cases with symptom progression must be treated with an endovascular approach by arterial or venous route. We report 30 patients with dural cavernous fistulas treated by coil embolization using surgical exposure and retrograde catheterization of the superior ophthalmic vein (SOV). The procedure resulted in closure of the fistula without other endovascular treatments in all 30 patients and clinical remission or improvement in 20 and eight patients, respectively. Embolization via a SOV approach is a safe and easy endovascular procedure, particularly indicated for dural cavernous fistulas with exclusive or prevalent internal carotid artery feeders and anterior venous drainage.

Keywords: cavernous sinus; dural cavernous fistula; embolization; superior ophthalmic vein.

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Figures

Figure 1
Figure 1
Surgical exposure of the superior ophthalmic vein (SOV). A small curvilinear incision was made (A) at level of the showen eyebrow to expose the SOV (B) and an angiocath was inserted into the vein for embolization procedure (C).
Figure 2
Figure 2
Left common carotid artery angiogram in anterior-posterior view (A) and lateral view (B). Dural fistula of the cavernous sinus draining anteriorly into the ectasic SOV.
Figure 3
Figure 3
Operative DSA (A) shows dural fistula of the anterior segment of the cavernous sinus. Microcatheter is placed in the SOV with distal tip in the cavernous sinus. Control DSA (B-C) after endovascular therapy with mechanical detachable coils showing total occlusion of the fistula.
Figure 4
Figure 4
Patient's clinical appearance before (A), early after the procedure (B) and during the follow-up (C).
See this image and copyright information in PMC

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