Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural...Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach(IAA) or the inferior petrosal sinus approach(IPSA).Methods:The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed.All patients underwent routine diagnostic digital subtraction angiography(DSA) before surgery.Embolization was performed using the IPSA through the internal jugular vein or IAA,based on angioarchitectural features.Results:Of the 32 patients with CSDAVF,24 underwent embolization treatment through the internal jugular veinIPSA and 8 patients underwent treatment through IAA.Nineteen patients in the IPSA group experienced mild headache,which improved after specific treatment.The immediate postembolization angiographic results revealed complete occlusion in 26 cases(18 IPSA and 8 IAA) and almost complete occlusion in 6 cases(IPSA).Complications that occurred during the procedure included abducens nerve palsy(n=1,IPSA) and prosopoplegia(n=1,IAA).One patient developed tinnitus,which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA,whereas the symptoms of other patients all improved with no recurrence.Conclusions:On the basis of the angioarchitectural features of CSDAVF,IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular,and when the microcatheter can easily reach the fistula through the artery.The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels.Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.展开更多
Objective： To evaluate the technical aspects, efficacy and safety in the treatment of cavernous dural arteriovenous fistulae （DAVF） by transvenous liquid n-Butyl cyanoacrylate （NBCA） injection combined with coils...Objective： To evaluate the technical aspects, efficacy and safety in the treatment of cavernous dural arteriovenous fistulae （DAVF） by transvenous liquid n-Butyl cyanoacrylate （NBCA） injection combined with coils placement in the cavemous sinus. Methods： Eight patients with cavernous DAVF, treated by transvenous embolization with combination of detachable coils and glue between February 2006 and February 2009 in our hospital, were retrospectively analyzed, including the clinical presentations, patterns of angioarchitecture, methods of treatment and the results of follow-up. Results： In all 8 patients, 9 transvenous and 1 transarterial interventions were carried out. A single endovascular procedure was performed in 6 patients and 2 patients had to be treated twice. Of the nine transvenous approaches, eight approaches were performed via inferior petrosal sinus （IPS） and 1 via the facial vein. Complete angiographic obliteration was achieved in all patients immediately after the embolization. There was no procedure-related morbidity except for mild headache for one to seven days after the embolization. Clinical cure was achieved in all cases during the clinical follow-up periods, ranging from 8 months to 3 years. The follow-up angiography periods averaged 6.6 months with a range of 5-9 months, in which no recurrence was observed. Conclusion： In this small series, embolization with combination of glue and detachable coils by transvenous approaches was a safe, effective and economical method for the treatment of part of symptomatic patients presenting with complex cavernous DAVE展开更多
Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistu...Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.展开更多
Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patie...Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.展开更多
Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a ...Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.展开更多
Dural arteriovenous fistulas(DAVFs)are rare vascular abnormalities that comprise 10%-15%of all intracranial arteriovenous malformations.The pathogenesis of DAVFs is still uncertain,although growing angiographic eviden...Dural arteriovenous fistulas(DAVFs)are rare vascular abnormalities that comprise 10%-15%of all intracranial arteriovenous malformations.The pathogenesis of DAVFs is still uncertain,although growing angiographic evidence supports the acquired characteristics of this vascular disease.Here,we present the case of a 39-year-old man with incidental bilateral paraophthalmic aneurysms who experienced spontaneous retroocular pressure and mild headache.Magnetic resonance angiography revealed enlargement and a change in the shape of the right paraophthalmic aneurysm.The patient underwent a right pterional craniotomy for the intracranial aneurysms.Five months later,he presented with progressive pulsatile tinnitus.A diagnostic angiogram demonstrated a Cognard type I DAVF of the right sigmoid sinus.Based on this case,angiography monitoring is recommended.Herein we review and summarize postoperative DAVF cases.Common causes of acquired DAVFs and treatment selection are discussed based on relevant literature.展开更多
Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of th...Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. Methods From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils （GDC, EDC, Matrix, Orbit or free coil） or coils plus silk. The patients were followed up for 3 to 26 months. Results All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus （2 patients） or the inferior petrosal sinus （1） after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. Conclusions Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.展开更多
文摘Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach(IAA) or the inferior petrosal sinus approach(IPSA).Methods:The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed.All patients underwent routine diagnostic digital subtraction angiography(DSA) before surgery.Embolization was performed using the IPSA through the internal jugular vein or IAA,based on angioarchitectural features.Results:Of the 32 patients with CSDAVF,24 underwent embolization treatment through the internal jugular veinIPSA and 8 patients underwent treatment through IAA.Nineteen patients in the IPSA group experienced mild headache,which improved after specific treatment.The immediate postembolization angiographic results revealed complete occlusion in 26 cases(18 IPSA and 8 IAA) and almost complete occlusion in 6 cases(IPSA).Complications that occurred during the procedure included abducens nerve palsy(n=1,IPSA) and prosopoplegia(n=1,IAA).One patient developed tinnitus,which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA,whereas the symptoms of other patients all improved with no recurrence.Conclusions:On the basis of the angioarchitectural features of CSDAVF,IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular,and when the microcatheter can easily reach the fistula through the artery.The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels.Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.
文摘Objective： To evaluate the technical aspects, efficacy and safety in the treatment of cavernous dural arteriovenous fistulae （DAVF） by transvenous liquid n-Butyl cyanoacrylate （NBCA） injection combined with coils placement in the cavemous sinus. Methods： Eight patients with cavernous DAVF, treated by transvenous embolization with combination of detachable coils and glue between February 2006 and February 2009 in our hospital, were retrospectively analyzed, including the clinical presentations, patterns of angioarchitecture, methods of treatment and the results of follow-up. Results： In all 8 patients, 9 transvenous and 1 transarterial interventions were carried out. A single endovascular procedure was performed in 6 patients and 2 patients had to be treated twice. Of the nine transvenous approaches, eight approaches were performed via inferior petrosal sinus （IPS） and 1 via the facial vein. Complete angiographic obliteration was achieved in all patients immediately after the embolization. There was no procedure-related morbidity except for mild headache for one to seven days after the embolization. Clinical cure was achieved in all cases during the clinical follow-up periods, ranging from 8 months to 3 years. The follow-up angiography periods averaged 6.6 months with a range of 5-9 months, in which no recurrence was observed. Conclusion： In this small series, embolization with combination of glue and detachable coils by transvenous approaches was a safe, effective and economical method for the treatment of part of symptomatic patients presenting with complex cavernous DAVE
文摘Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.
文摘Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.
文摘Although recurrent traumatic carotid-cavernous fistula （CCF） and its treatment have beenreported sporadically,^1 a complex cavernous sinus dural arteriovenous fistula （DAVF） secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2- cyanoacrylate （NBCA）. The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.
文摘Dural arteriovenous fistulas(DAVFs)are rare vascular abnormalities that comprise 10%-15%of all intracranial arteriovenous malformations.The pathogenesis of DAVFs is still uncertain,although growing angiographic evidence supports the acquired characteristics of this vascular disease.Here,we present the case of a 39-year-old man with incidental bilateral paraophthalmic aneurysms who experienced spontaneous retroocular pressure and mild headache.Magnetic resonance angiography revealed enlargement and a change in the shape of the right paraophthalmic aneurysm.The patient underwent a right pterional craniotomy for the intracranial aneurysms.Five months later,he presented with progressive pulsatile tinnitus.A diagnostic angiogram demonstrated a Cognard type I DAVF of the right sigmoid sinus.Based on this case,angiography monitoring is recommended.Herein we review and summarize postoperative DAVF cases.Common causes of acquired DAVFs and treatment selection are discussed based on relevant literature.
文摘Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. Methods From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils （GDC, EDC, Matrix, Orbit or free coil） or coils plus silk. The patients were followed up for 3 to 26 months. Results All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus （2 patients） or the inferior petrosal sinus （1） after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. Conclusions Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.
