Ahead of Print: Superselective Shunt Occlusion for CSdAVFs

Screen Shot 2013-04-25 at 9.31.06 AMBackground: In treating cavernous sinus dural arteriovenous fistulas (CSdAVFs), transvenous embolization of the whole affected sinus is usually performed, which may result in the disturbance of normal venous drainage, or permanent cranial nerve palsy.

Objective: To describe superselective shunt occlusion (SSSO) of CSdAVFs.

Methods: Between July 2005 and August 2011, we experienced 20 consecutive CSdAVFs. In 14 cases (70%), we could detect the restricted locus of arteriovenous shunts by way of three-dimension rotational angiography (3-D RA) and/or superselective arteriography. After navigating the microcatheter to the shunt segment, consecutive superselective arterio-venography was performed to confirm the location of the microcatheter at the proper position.

Results: In 12 of 14 cases (85.7 %) in which the shunt was restricted, coiling only in the small venous pouch or compartment, which was just downstream of the shunt point, led to complete disappearance of the shunt without obliterating the entire sinus. No recurrence or permanent cranial nerve palsy was observed during the follow-up period with a mean of 46 (3 to 69) months in 12 cases treated by SSSO.

Conclusion: This technique, which enables complete extirpation of shunts by small amounts of coils, is a feasible way to treat CSdAVFs with excellent mid- to long-term results. Understanding of the angioarchitecture by 3-D RA and consecutive superselective arterio-venography was useful. This method should be considered before sinus packing or mere obliteration of dangerous venous outlets.

From: Superselective Shunt Occlusion for the Treatment of Cavernous Sinus Dural Arteriovenous Fistulas by Satow et al.

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