title: Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus Through Percutaneous Ultrasound-Guided Puncture of the Facial Vein.
abstract: BACKGROUND
  The goal of dural arteriovenous fistula of the cavernous sinus treated with coils through ultrasound-guided access to the facial vein is to interrupt the fistulous communications and decrease the pressure in the cavernous sinus and consequently in the ophthalmic veins. The traditional approach in the treatment of these fistulae is transvenous endovascular occlusion of the cavernous sinus. Transvenous embolization has been proven to be safe and can provide complete and permanent occlusion of the fistula in a single session. The most commonly used venous pathway is the inferior petrosal sinus, but, if it is inaccessible, then, the superior ophthalmic vein is considered; nonetheless, it can require a surgical exposure. Other pathways include the transfemoral transfacial vein. An arterial approach is considered usually when venous approach pathways fail. Arterial occlusion of feeders supplying the fistula is associated with a greater risk of embolic complications.
  
  
  METHODS
  We report a case of dural arteriovenous fistula of the cavernous sinus treated with coils through ultrasound-guided access to the facial vein.
  
  
  CONCLUSIONS
  We propose an alternative pathway when the conventional transvenous approach through the inferior petrosal sinus is excluded. An ultrasound-guided facial vein approach can be considered as a direct and safe alternative to reach the cavernous sinus and obtain exclusion of the fistula.
authors.affiliation: Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. Electronic address: andrea.alexandre@libero.it.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Alexandre
authors.affiliation: Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Visconti
authors.affiliation: Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Lozupone
authors.affiliation: Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Argento
authors.affiliation: Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pedicelli
mesh_terms: D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography
keywords: Carotido-cavernous fistula; Cavernous sinus; DAVF; Dural arteriovenous fistula; Ultrasound-guided access