title: Superselective shunt occlusion for the treatment of cavernous sinus dural arteriovenous fistulae.
abstract: BACKGROUND
  In treating cavernous sinus dural arteriovenous fistulae (CSdAVFs), transvenous embolization of the whole affected sinus is usually performed, which may result in the disturbance of normal venous drainage or permanent cranial nerve palsy.
  
  
  OBJECTIVE
  To describe superselective shunt occlusion of CSdAVFs.
  
  
  METHODS
  Between July 2005 and August 2011, we had 20 consecutive cases of CSdAVFs. In 14 cases (70%), we could detect the restricted locus of arteriovenous shunts by 3-dimensional rotational angiography and/or superselective arteriography. After navigating the microcatheter to the shunt segment, consecutive superselective arteriovenography was performed to confirm the location of the microcatheter at the proper position.
  
  
  RESULTS
  In 12 of 14 cases (85.7%) in which the shunt was restricted, coiling only in the small venous pouch or compartment, which was just downstream of the shunt point, led to complete disappearance of the shunt without obliterating the entire sinus. No recurrence or permanent cranial nerve palsy was observed during the follow-up period with a mean of 46 months (range, 3-69 months) in 12 cases treated by superselective shunt occlusion.
  
  
  CONCLUSIONS
  This technique, which enables complete extirpation of shunts by small amounts of coils, is a feasible way to treat CSdAVFs with excellent mid- to long-term results. Understanding of the angioarchitecture by 3-dimensional rotational angiography and consecutive superselective arteriovenography was useful. This method should be considered before sinus packing or mere obliteration of dangerous venous outlets.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. tetsus@hsp.ncvc.go.jp
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.forename: Kenichi
authors.initials: K
authors.lastname: Murao
authors.forename: Toshinori
authors.initials: T
authors.lastname: Matsushige
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000000981:diagnostic imaging* / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult