title: A new transvenous approach to the carotid-cavernous sinus via the inferior petrooccipital vein.
abstract: OBJECTIVE
  The transvenous approach via the inferior petrosal sinus (IPS) is commonly used as the most appropriate for carotid-cavernous fistula (CCF) or cavernous sinus sampling. However, sometimes the IPS is not accessible because of anatomical problems and/or complications, therefore an alternative route is needed. In this paper, the authors present and discuss the utility of a transvenous approach to the cavernous sinus via the inferior petrooccipital vein.
  
  
  METHODS
  Four patients, 3 with dural CCFs and the other with Cushing disease, in whom endovascular surgical attempts failed using a conventional venous approach via the IPS, underwent a transvenous approach to the cavernous sinus via the inferior petrooccipital vein (IPOV). One dural CCF case had only cortical venous drainage, the second CCF also mainly drained into the cortical vein with slight inflow into the superior ophthalmic vein and inferior ophthalmic vein, and the third demonstrated drainage into the superior and inferior ophthalmic veins and IPOV.
  
  
  RESULTS
  In all cases, the cavernous sinus could be accessed successfully via this route and without complications.
  
  
  CONCLUSIONS
  The transvenous approach to the cavernous sinus via the IPOV should be considered as an alternative in cases when use of the IPS is precluded by an anatomical problem and there are no other suitable venous approach routes.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamik Sagamihara, Kanagawa 228-8555, Japan. akirak@med.kitasato-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Kurata
authors.forename: Sachio
authors.initials: S
authors.lastname: Suzuki
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Iwamoto
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Nakahara
authors.forename: Madoka
authors.initials: M
authors.lastname: Inukai
authors.forename: June
authors.initials: J
authors.lastname: Niki
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Satou
authors.forename: Masaru
authors.initials: M
authors.lastname: Yamada
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kan
authors.forename: Toshiro
authors.initials: T
authors.lastname: Katsuta
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery*; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D002426:Cavernous Sinus / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000098:blood supply*; D010579:Petrous Bone / Q000098:blood supply*; D011859:Radiography