Transvenous Embolization Of Cavernous Sinus Dural Arteriovenous Fistula Via The Inferior Petrosal Sinus With Detachable Coils And Onyx-18

OBJECTIVE:To assess the efficacy of transvenous embolization of CSdAVF (cavernous sinus dural arteriovenous fistula) via the IPS (inferior petrosal sinus) with detachable coils and Onyx-18.MATERIALS AND METHODS:Between March2009and December2011, fourteen patients with the CSdAVF were treated transvenous embolization via the inferior petrosal sinus using detachable coils and Onyx-18in our hospital. In all patients (7females and7males), CSdAVF was confirmed by conventional angiography. One patient was treated only by Onyx-18and others were treated by Onyx-18combined with coils. All patients had good outcome and the median follow up time was15months ranging from3to30months.RESULTS:All patients experienced clinical improvement. The lesion only treated with Onyx-18was embolized incompletely and then the patient received carotid compression therapy. Complications were encountered in8patients, including postoperative headache, cranial nerve III palsy aggravation and reflex bradycardia. No patients had recurrent symptoms during the follow-up period. CONCLUSIONS:Transvenous embolization via the inferior petrosal sinus provides a major method in the endovascular treatment of CSdAVFs. Cavernous sinus is divided in to many cavities by trabeculas. Only the microcatheter being inserted into the’ responsible cavity’, Onyx-18combined with coils make it possible to cure the CSdAVF. The IPS is similar with the CS, an unbroken, trabeculated and venous channel but without complicated structures. Appropriate mechanical recanalization in the unopacified sinus has a good result. It is vital to maintain anatomy of the cavernous sinus and the IPS for prognosis and management. The careful operation is the essential guarantee of the successful treatment.