title: Surgical cannulation of a cortical draining vein for endovascular treatment of a dural arteriovenous fistula of the cavernous sinus.
abstract: Dural arteriovenous fistulas (DAVF) of the cavernous sinus most commonly present with ocular symptoms and can be observed or treated with endovascular approaches, surgery, or radiosurgery. Combined surgical-endovascular approaches have been used for fistulas that are not amenable to standard endovascular approaches. A 40-year-old man presented with ocular symptoms from a cavernous sinus DAVF. Multiple previous transarterial and transvenous embolization attempts had failed. The patient underwent craniotomy for surgical exposure and cannulation of an arterialized sylvian vein. Subsequently he underwent coiling and onyx embolization of the DAVF. The intervention resulted in effective obliteration of the fistula. If a cavernous sinus DAVF is refractory to treatment, surgical exposure and cannulation of a cortical draining vein can facilitate transvenous endovascular treatments.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030, USA. jgthomas@bcm.edu
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Thomas
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
authors.forename: Michel E
authors.initials: ME
authors.lastname: Mawad
authors.forename: Edward A M
authors.initials: EA
authors.lastname: Duckworth
mesh_terms: D000328:Adult; D002404:Catheterization / Q000379:methods*; D002426:Cavernous Sinus / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D003399:Craniotomy; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods