J Cerebrovasc Endovasc Neurosurg.  2021 Dec;23(4):293-303. 10.7461/jcen.2021.E2021.04.002.

Endovascular management of cavernous sinus dural arteriovenous fistulas: Overall review and considerations

• Lee JM
• Park ES
• Kwon SC

• KMID: 2523887
• DOI: http://doi.org/10.7461/jcen.2021.E2021.04.002

Abstract

Cavernous sinus dural arteriovenous fistulas (CSDAVFs) are arteriovenous shunts between small dural branches arising from the external and/or internal carotid arteries and the cavernous sinus (CS). And now a days, endovascular treatment is the treatment of choice in CSDAVF. We review the anatomy and classifications of CSDAVFs, discussing and detailing these considerations in the treatment of CSDAVFs, theoretically and in the light of recent literatures.

Keyword

Dural arteriovenous fistula, Carotid cavernous fistula, Cavernous sinus

Figure

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  Fig. 1. The patient experienced right exophthalmos and ocular pain. Left ECA angiogram AP (A) and Lat (B) revealed CSDAVF supplied by dural arteries of ECA and venous reflux to the right SOV through the intercavernous sinus. The microcatheter was advanced into the CS via right IPS. Subsequently, the coils were packed at the junction of SOV and CS (C, D). On follow-up angiogram, venous reflux was noted again (E). Therefore, additional packing coils were inserted in the intercavernous sinus (F). On follow-up angiogram, venous reflux into SOV disappeared (G, H). The patient’s symptoms were relived after the surgery. ECA, external carotid artery; AP, anteroposterior; Lat, lateral; CSDAVF, cavernous sinus dural arteriovenous fistula; SOV, superior ophthalmic vein; CS, cavernous sinus; IPS, inferior petrous sinus.

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  Fig. 2. The patient complained of left exophthalmos and chemosis. On left ICA angiogram AP (A) and Lat (B), CSDAVF supplied by dural arteries of cavernous ICA was noted. The microcatheter was advanced into the CS via SOV (C, D). Note that coil packing was performed from the posterior portion of the CS anteriorly (E, F). On follow-up angiogram, venous reflux to SOV disappeared (G, H). ICA, internal carotid artery; AP, anteroposterior; Lat, lateral; CSDAVF, cavernous sinus dural arteriovenous fistula; CS, cavernous sinus; SOV, superior ophthalmic vein.

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  Fig. 3. On right ECA angiogram AP (A) and Lat (B), CSDAVF supplied by accessory meningeal arterial feeder and venous reflux to SOV were noted. This single arterial feeder was occluded using transarterial Onyx embolization (C). On follow-up angiogram, CSDAVF had disappeared (D, E). The patient had presented with ocular pain and exophthalmos. After the procedure, the symptoms were relieved immediately. ECA, external carotid artery; AP, anteroposterior; Lat, lateral; CSDAVF, cavernous sinus dural arteriovenous fistula; SOV, superior ophthalmic vein.

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