title: A venographic operational classification for transvenous embolization of dural carotid-cavernous fistula.
abstract: BACKGROUND
  It is hypothesized that a venographic-based operational classification of dural carotid-cavernous fistula (DCCF) will facilitate early selection of the optimal venous route and enhance the efficacy of transvenous catheterization and embolization of the cavernous sinus.
  
  
  METHODS
  This was a retrospective study on 97 patients who presented with symptomatic DCCF. Definition of classification type 1: both the anterior and posterior compartments of the cavernous sinus were opacified, type 2: only the anterior compartment was opacified, type 3: only the posterior compartment was opacified. Subtype a: the facial vein (FV) draining the superior ophthalmic vein (SOV) was opacified, subtype b: only the inferior petrosal sinus (IPS) was opacified, subtype c: neither the FV nor the IPS were opacified, subtype d: both the FV and the IPS were opacified. The SOV route was recommended for subtype 1a and type 2. The IPS route was recommended for subtype 1b, 1c, 1d, and type 3. Success rates of catheterization by the recommended routes and non-recommended routes were calculated.
  
  
  RESULTS
  Number of DCCF lesions were 20 (1a), 28 (1b), 23 (1c), 26 (1d), 16 (2a), 10 (2c), 2 (3b). Of 145 attempted catheterization, 91 and 54 were performed with a recommended route and un-recommended route, respectively. Success rate for catheterization and embolization performed with the recommended route and un-recommended route was 71/91 (78%) and 20/54 (37%), respectively (Chi-Square test P = 0.0024).
  
  
  CONCLUSIONS
  Venographic operational classification is useful for guiding the selection of optimal venous route which enhances the efficacy of transvenous embolization of the DCCF.
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. simonyu@cuhk.edu.hk
authors.forename: Simon C H
authors.initials: SC
authors.lastname: Yu
authors.forename: K M
authors.initials: KM
authors.lastname: Cheng
authors.forename: Patrick H T
authors.initials: PH
authors.lastname: Tam
authors.forename: George K C
authors.initials: GK
authors.lastname: Wong
authors.forename: C M
authors.initials: CM
authors.lastname: Chan
authors.forename: Y L
authors.initials: YL
authors.lastname: Cheung
authors.forename: W S
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D006490:Hemostatics