J Neurocrit Care.  2019 Dec;12(2):102-107. 10.18700/jnc.190089.

Transvenous Onyx embolization of cavernous sinus dural arteriovenous fistula using a balloon catheter in the arterial side for flow control

• Kang CH
• Roh J
• Yeom JA
• Lee SW
• Baik SK

• KMID: 2470472
• DOI: http://doi.org/10.18700/jnc.190089

Abstract

BACKGROUND
Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts involving the dura mater, located within or near the walls of the CS. Transvenous embolization is considered to be an effective treatment for CS DAVF. We describe a novel technique for the use of transvenous Onyx embolization in the treatment of CS DAVF, which uses a temporary balloon to occlude the arterial side for flow control.
CASE REPORT
A 63-year-old woman presented with ocular pain and ptosis of the left eye. Cerebral angiography showed a left CS DAVF fed by multiple branches of the left external carotid artery. We successfully treated the CS DAVF using transvenous Onyx embolization with temporary balloon occlusion of the proximal feeding artery to decrease the shunted flow.
CONCLUSION
Transvenous Onyx embolization with flow control via temporary balloon occlusion may be a useful technique for the embolization of CS DAVFs with multiple arterial feeders.

Keyword

Cavernous sinus; Arteriovenous fistula; Endovascular technique; Balloon occlusion

MeSH Terms

Arteries
Arteriovenous Fistula
Balloon Occlusion
Carotid Artery, External
Catheters*
Cavernous Sinus*
Central Nervous System Vascular Malformations*
Cerebral Angiography
Dura Mater
Endovascular Procedures
Female
Humans
Middle Aged

Figure

• 

  Fig. 1. Left external carotid artery (ECA) angiography, (A) frontal projection and (B) lateral projection, showing a left cavernous sinus (CS) dural arteriovenous fistula fed by the left distal internal maxillary artery, the left middle meningeal artery, and the left ascending pharyngeal artery, drained to the both superior ophthalmic vein (left side dominant) and the both inferior petrosal sinus (right side dominant). (C) Right internal carotid artery (ICA) angiography and (D) left ICA angiography, showing shunted flow from the bilateral meningohypophyseal trunk to the CS.

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  Fig. 2. (A) Native image, lateral projection showing deployed coil at the orifice of superior ophthalmic vein and inflated balloon into the proximal left external carotid artery (ECA). (B) Left ECA angiography during balloon inflation, lateral projection showing diminished blood flow from the left ECA. (C) Final Onyx cast. (D) Final angiography of the left ECA, frontal projection showing complete obliteration of the cavernous sinus dural arteriovenous fistula.

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  Fig. 3. Left external carotid artery angiography at 6-month post-embolization, (A) frontal projection and (B) lateral projection showing complete obliteration of the cavernous sinus dural arteriovenous fistula.

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