title: Neuromeningeal access for transarterial intravenous carotid-cavernous fistula embolization.
abstract: While numerous endovascular access routes have been described for carotid-cavernous fistula (CCF) treatment, transarterial embolization via the neuromeningeal trunk of the ascending pharyngeal artery is typically avoided due to the risk of cranial nerve palsy or non-target embolization via external-to-internal carotid anastamoses. We present the case of a dural CCF in which access to the venous side of the fistula was achieved via the neuromeningeal trunk and allowed for curative transarterial intravenous coil/liquid embolic embolization of the lesion. The utility of a transarterial intravenous approach in the face of venous sinus occlusion is highlighted. The neuromeningeal trunk should not be overlooked as a potential access route for transarterial intravenous CCF embolization in cases where traditional endovascular access is limited; this approach does not carry the same risks that are generally associated with pure transarterial embolization along this pathway.
authors.affiliation: Departments of Neurosurgery and Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Ashour
authors.affiliation: Departments of Neurosurgery and Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA rchavali@partners.org.
authors.forename: Ram
authors.initials: R
authors.lastname: Chavali
mesh_terms: D001158:Arteries / Q000000981:diagnostic imaging; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D003392:Cranial Sinuses / Q000601:surgery; D004121:Dimethyl Sulfoxide; D004172:Diplopia / Q000209:etiology; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D008578:Meninges / Q000033:anatomy & histology*; D008875:Middle Aged; D010614:Pharynx / Q000098:blood supply; D011145:Polyvinyls; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Neuromeningeal trunk; Onyx; ascending pharyngeal artery; carotid-cavernous fistula; embolization; endovascular treatment