Double microcatheter technique for transvenous embolization of cavernous sinus dural arterio-venous fistulas

Abstract

Objective: We describe a double microcatheter technique for transvenous embolization (TVE) of cavernous sinus dural arterio-venous fistulas (CSdAVFs).
Method: Eleven patients with CSdAVF were treated by TVE. We tried to navigate two microcatheters through the inferior petrosal sinus to the cavernous sinus (CS) and catheterized to the veins which had shown retrograde leptomeningeal venous drainage (RLVD), and the superior ophthalmic vein (SOV). We evaluated success rate of navigation of double microcatheters to the CS, success rate of superselective catheterization to the RLVD and the SOV, and angiographical and clinical cure rates.
Result: We performed 13 sessions of TVE for 11 patients. Two microcatheters were successfully navigated to the CS in 11 of 13 sessions (85%). The microcatheters were successfully catheterized to all of the RLVD and the SOV superselectively. In one case, we were able to transfer one of the two microcatheters to the new RLVD, which appeared during embolization of pre-existing RLVD, and were able to occlude dangerous drainage immediately. Both angiographical and clinical cure rates at the initial treatment were 82%, and final angiographic and clinical cure rates were 100%.
Conclusion: A double microcatheter technique for TVE of CSdAVF is a safe and useful procedure with good angiographical and clinical outcomes.