title: Transvenous embolization of cavernous sinus dural arteriovenous fistula via angiographic occlusive inferior petrous sinus.
abstract: BACKGROUND
  Trans-inferior petrous sinus (IPS) coil embolization is an efficient and safe method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some CSDAVFs may be associated with angiographic occlusive IPS making access difficult. The purpose of this study was to report our experience of transvenous embolization of the CSDAVF via angiographic occlusive IPS.
  
  
  METHODS
  We reviewed the cases of 20 patients who underwent transvenous embolization via angiographic occlusive IPS over a 6 year period. The study consisted of seven men and 13 women, ranging from 46 years to 78 years of age (mean, 60 years). We retrospectively analyzed the angioarchitecture of the CSDAVFs, the procedural time and the angiographic as well as the clinical outcomes after embolization.
  
  
  RESULTS
  True occlusive IPS was found in 13 of the patients, while patent IPS with compartment of the IPS-CS was demonstrated in the remaining seven patients. The microcatheter was successfully navigated to the fistula site of the CS in 16 patients (80%), while such navigation failed in four patients following numerous attempts. The mean procedural times for truly occlusive IPS and for compartment of the IPS-CS were 111 minutes and 129 minutes, respectively. No recurrent fistula was observed on follow-up neuroimages. Three patients had transient third or sixth cranial nerve palsy, and one patient had perforation of the IPS leading to temporary headache. The mean clinical follow-up period was 18 months.
  
  
  CONCLUSIONS
  Angiographic occlusive IPS of CSDAVF may be related to true occlusion of IPS or patent IPS with compartment of the IPS-CS. There is no statistically significant difference in procedural times for these two different fistula anatomies. Transvenous embolization via angiographic occlusive IPS is a safe and effective method to manage CSDAVFs.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC. Electronic address: cbluo@vghtpe.gov.tw.
authors.forename: Chao-Bao
authors.initials: CB
authors.lastname: Luo
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Michael Mu-Huo
authors.initials: MM
authors.lastname: Teng
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
authors.affiliation: Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC.
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Ting
mesh_terms: D000368:Aged; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000000981:diagnostic imaging; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: cavernous sinus; dural arteriovenous fistula; embolization; inferior petrous sinus