title: Onyx embolization of cavernous sinus dural arteriovenous fistulas via direct transorbital puncture under the guidance of three-dimensional reconstructed skull image (reports of six cases).
abstract: BACKGROUND
  Because of complex angioarchitecture, the transarterial or venous pathway is not feasible for some cavernous sinus dural arteriovenous fistulas (CS DAVFs). We present six cases in which onyx embolization of a CS DAVFs was made possible through direct transorbital puncture.
  
  
  METHODS
  In the present study, all patients were penetrated through one third of the medial-lateral of the inferior orbital rim under the guidance of fluoroscopy superimposed on the three-dimensional reconstructed skull image to complete embolization (onyx with or without coils). The records of patient demographics, clinical manifestation, fistula features, procedures, clinical outcome and angiographic outcome were reviewed and analyzed.
  
  
  RESULTS
  In our series of six patients, the immediate angiographic result showed complete occlusion in all patients. The six patients experienced retrobulbarhematoma and eye swelling right after embolization, while the swelling significantly subsided after 3-5 days of conservative treatment. During the postoperative angiography and clinical follow-up (4-10 months), one of the patients had decreased visual acuity; the other five patients did not have neurological dysfunction.
  
  
  CONCLUSIONS
  Onyx embolization via direct transorbital puncture provides a method to be considered to treat CS DAVFs when the conventional transvenous approaches are inaccessible.
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, 100050, China, liuaihua_ttyy@126.com.
authors.forename: Aihua
authors.initials: A
authors.lastname: Liu
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.forename: Zenghui
authors.initials: Z
authors.lastname: Qian
authors.forename: Tangming
authors.initials: T
authors.lastname: Peng
authors.forename: Youxiang
authors.initials: Y
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
authors.forename: Chuhan
authors.initials: C
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D011145:Polyvinyls / Q000627:therapeutic use; D011677:Punctures / Q000379:methods; D011859:Radiography; D012886:Skull / Q000000981:diagnostic imaging* / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide