title: Occlusion of a clival dural arteriovenous fistula using a novel approach through the foramen ovale.
abstract: Dural arteriovenous fistulas (DAVFs) are abnormal connections between arteries and veins that are classified by location, morphology or direction of venous drainage. Treatment of DAVFs is undertaken in patients with severe symptoms or those with retrograde cortical venous drainage and/or venous ectasia. Much is written regarding the treatment of DAVFs involving the transverse sigmoid sinuses, cavernous sinus and tentorium, but little is written concerning the treatment of clival DAVFs. We demonstrate a novel transforaminal percutaneous approach through the foramen ovale as a viable method to occlude a clival vein. Specialised software was used to create a safe trajectory to the DAVF via the foramen ovale. The patient then underwent successful occlusion of the clival DAVF, thus further increasing the neurointerventionalist's armamentarium when attempting to treat difficult to reach clival DAVFs.
authors.affiliation: Diagnostic Radiology, Kaiser Permanente-Los Angeles Medical Center, Los Angeles, California, USA.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Urdaneta-Moncada
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Joseph
authors.initials: J
authors.lastname: Chen
mesh_terms: D000368:Aged; D001763:Blepharoptosis / Q000209:etiology; D001766:Blindness / Q000209:etiology; D002311:Cardiomyopathy, Dilated / Q000150:complications; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D004121:Dimethyl Sulfoxide; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D054085:Foramen Ovale / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D019635:Neurosurgical Procedures / Q000379:methods*; D009886:Ophthalmoplegia / Q000209:etiology; D011145:Polyvinyls; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide