Percutaneous transorbital direct puncture to obliterate a cavernous sinus dural arteriovenous fistula. (8th March 2021)

• Record Type: Journal Article
• Authors: Cavalcanti, Daniel D; Raz, Eytan; Shapiro, Maksim; Mir, Osman; Nossek, Erez; Nelson, Peter Kim
• Is Part Of: Journal of neurointerventional surgery. Volume 13:Number 12(2021)
• Page Start: 1190
• Page End: 1190
• Publication Date: 2021-03-08
• Subjects: arteriovenous malformation -- coil -- fistula -- orbit -- navigation; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-017118
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Cavernous sinus dural arteriovenous fistulas (CS-DAVF) can have an indolent course, with insidious onset, but still showing a high likelihood of spontaneous resolution. 1 Nevertheless, symptoms in a subset of patients evolve more rapidly, with malignant signs on imaging, warranting intervention. 2 We report on a patient in his 40s presenting with redness and proptosis of the right eye, intermittent blurred vision and diplopia. Once ophthalmological examination revealed increased intraocular pressure and imaging showed cortical venous congestion, the decision was made to obliterate a CS-DAVF involving the posteromedial right cavernous sinus. Multiple arteries including branches of the ascending pharyngeal artery, occipital artery and bilateral meningohypophyseal trunks supplied the fistula. Once transarterial embolization was deemed unsafe and both inferior petrosal sinuses did not grant access to the right cavernous sinus, a direct puncture to the cavernous sinus was performed to successfully coil the involved compartments. 3–5 The aid of DynaCT imaging and needle guidance software is emphasized ( video 1 ).