Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas via Direct Transorbital Puncture Using Cone-Beam Computed Tomography Image Guidance: Report of 3 Cases

Certain cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are difficult to access through transarterial or transvenous routes and may necessitate access through direct transorbital puncture of the superior ophthalmic vein (SOV) or the CS. However, to be successful, the accurate design of the...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2019-10, Vol.130, p.306-312
Main Authors: Fu, Zheng-Yi, Feng, Yu, Ma, Chao, Chen, Jin-Cao, Krings, Timo, Zhao, Wen-Yuan
Format: Article
Language:English
Subjects:
Cavernous Sinus - surgery
Central Nervous System Vascular Malformations - diagnosis
Central Nervous System Vascular Malformations - surgery
Cerebral Angiography - methods
Cone-Beam Computed Tomography - methods
Embolization, Therapeutic - methods
Humans
Male
Middle Aged
Orbit - surgery
Punctures - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Certain cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are difficult to access through transarterial or transvenous routes and may necessitate access through direct transorbital puncture of the superior ophthalmic vein (SOV) or the CS. However, to be successful, the accurate design of the puncture route and guidance are crucial. This study aimed to report our preliminary clinical experience using cone-beam computed tomography (CT) with real-time fluoroscopic overlays for image guidance during transorbital needle puncture. Between December 2017 and July 2018, 3 patients with CS DAVFs were treated via a transorbital puncture to establish access to the CS under the guidance of XperGuide planning software either via direct CS puncture or through the SOV. The guidance trajectory was superimposed onto the real-time fluoroscopic image during needle puncture. Once access was established, the CS DAVFs were treated with a combination of liquid embolic materials and coils. Image guidance aided to avoid at-risk structures and treatment resulted in all cases in complete obliteration of the CS DAVFs as verified by control angiography without peri- or postprocedural complications. Endovascular embolization of CS DAVFs via direct transorbital puncture aided by image guidance provided an alternative option when more conventional approaches are deemed not possible.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.07.002