Transvenous Embolization of Cavernous and Paracavernous Dural Arteriovenous Fistula through the Facial Vein: Report of 12 Cases
A 55-year-old man was admitted with dysarthria, left exophthalmos, chemosis and left-side motor weakness. Brain computed tomographic angiography (CTA) revealed acute intracranial hemorrhage in right capsular region and tangled vessels of right temporal area with early venous drainage. Digital subtraction angiography (DSA) showed DAVF involving CS with arterial feeders from right external carotid artery (ECA) and internal carotid artery (ICA), venous drainage to left SOV, right sphenoparietal sinus and superficial middle cerebral vein, thought as dangerous retrograde cortical drainage, through intercavernous sinus (). We decided to occlude the fistula by coil embolization via venous route. Under general anesthesia, initially a guiding catheter was placed in the left IJV to FV and a microcatheter - exchanged Prowler select plus to Excelsior SL-10 straight because of tortuous angular vein - could be introduced in left CS through SOV by a microwire (Transend 0.014, Boston Scientific, Natick, MA, USA). However, the microwire and microcatheter could not be passed through intercavernous sinus, so the microwire was changed to Agility 14 Soft microwire (Codman & Shurtleff, Rayham, MA, USA). The microcatheter was then exchanged with Prowler select plus (Codman, USA), and it was advanced to the transition site between the right CS and sphenoparietal sinus (). The fistula site in the CS was completely occluded by embolization using detachable and pushable fibered coils through from right to left CS involving intercavernous portion. The patient discharged with no neurological deficit.