title: Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula With Ipsilateral Inferior Petrosal Sinus Occlusion: A Single-Center Experience.
abstract: BACKGROUND
  Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus.
  
  
  OBJECTIVE
  To describe our experience with endovascular treatment of CSdAVF complicated by ipsilateral IPS occlusion.
  
  
  METHODS
  From January 2003 through September 2014, a total of 49 CSdAVFs with ipsilateral IPS occlusion were identified in 49 patients, who then underwent endovascular treatment. Clinical and radiologic data were retrospectively reviewed.
  
  
  RESULTS
  Either transvenous (n = 38) or transarterial (n = 11) access was initially elected, the latter reserved for single-hole or dominant arterial feeder fistulas. Access via occluded ipsilateral IPS was usually attempted (n = 34) by transvenous approach, with a 54.3% success rate. Anterior (n = 3) or posterior (n = 1) facial vein was alternatively used. Direct surgical exposure of ophthalmic vein (n = 3) or radiosurgery (n = 4) was performed for access failure or unsuccessful occlusion by other means. In 46 fistulas (93.9%), complete occlusion was achieved, with no procedure-related morbidity or mortality. Postprocedural symptom improvement was noted in all but 2 patients, who separately experienced paradoxical worsening of cranial nerve palsy and access failure.
  
  
  CONCLUSIONS
  In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.
authors.affiliation: Departments of *Radiology and ‡Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jong Kook
authors.initials: JK
authors.lastname: Rhim
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Cho
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Park
authors.forename: Jin Pyeong
authors.initials: JP
authors.lastname: Jeon
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D002404:Catheterization; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery; D002550:Cerebral Veins / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000209:etiology; D003392:Cranial Sinuses / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome