title: Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.
abstract: Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.
authors.affiliation: Department of Neurosurgery, Shiroyama Hospital, Habikino, Osaka, Japan; Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan. Electronic address: fukudaharpseal@gmail.com.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Miyake
authors.affiliation: Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Takenobu
authors.initials: T
authors.lastname: Kunieda
authors.affiliation: Department of Neurosurgery, Shiroyama Hospital, Habikino, Osaka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Murao
mesh_terms: D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D003392:Cranial Sinuses / Q000601:surgery*; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Dural arteriovenous fistula; cortical venous drainage; endovascular treatment; sphenoid wing; transarterial embolization; transvenous embolization