title: Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas.
abstract: OBJECTIVE
  To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques.
  
  
  METHODS
  One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils.
  
  
  RESULTS
  Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas.
  
  
  CONCLUSIONS
  Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Lv
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China dragontiger@163.com.
authors.forename: Chuhan
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China.
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Ning
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Interventional Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, China.
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000328:Adult; D002426:Cavernous Sinus / Q000000981:diagnostic imaging*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging* / Q000601:surgery*; D009916:Orbital Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use; D011677:Punctures; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Dural arteriovenous fistula; cavernous sinus; embolisation; transorbital puncture