Limits...
Transcranial direct middle meningeal artery puncture for the onyx embolization of dural arteriovenous fistula involving the superior sagittal sinus.

Oh JS, Yoon SM, Shim JJ, Bae HG - J Korean Neurosurg Soc (2015)

Bottom Line: The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux.Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough.Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

ABSTRACT
A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

No MeSH data available.


Related in: MedlinePlus

Angiography depicting dural arteriovenous fistulas on superior saggittal sinus (SSS) fed by both middle meningeal arteries (arrowheads), superficial temporal arteries (arrows) and occipital arteries (A) and draining into the occluded SSS retrograde fashion, then marked reflux to bilateral superficial cortical veins (B). There was no feeder from both internal carotid arteries and most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4323506&req=5

Figure 2: Angiography depicting dural arteriovenous fistulas on superior saggittal sinus (SSS) fed by both middle meningeal arteries (arrowheads), superficial temporal arteries (arrows) and occipital arteries (A) and draining into the occluded SSS retrograde fashion, then marked reflux to bilateral superficial cortical veins (B). There was no feeder from both internal carotid arteries and most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (C).

Mentions: Angiography depicted a dAVFs on the SSS fed by both MMAs, superficial temporal arteries (STAs) and occipital arteries (OAs) and drained into the occluded SSS retrograde fashion, then mark-ed reflux to bilateral superficial cortical veins. There was no feeder from both internal carotid arteries. Because the SSS was occluded at the posterior one third, most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (Fig. 2). These dAVFs were classified as type IIa+IIb according to Cognard et al.1).


Transcranial direct middle meningeal artery puncture for the onyx embolization of dural arteriovenous fistula involving the superior sagittal sinus.

Oh JS, Yoon SM, Shim JJ, Bae HG - J Korean Neurosurg Soc (2015)

Angiography depicting dural arteriovenous fistulas on superior saggittal sinus (SSS) fed by both middle meningeal arteries (arrowheads), superficial temporal arteries (arrows) and occipital arteries (A) and draining into the occluded SSS retrograde fashion, then marked reflux to bilateral superficial cortical veins (B). There was no feeder from both internal carotid arteries and most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4323506&req=5

Figure 2: Angiography depicting dural arteriovenous fistulas on superior saggittal sinus (SSS) fed by both middle meningeal arteries (arrowheads), superficial temporal arteries (arrows) and occipital arteries (A) and draining into the occluded SSS retrograde fashion, then marked reflux to bilateral superficial cortical veins (B). There was no feeder from both internal carotid arteries and most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (C).
Mentions: Angiography depicted a dAVFs on the SSS fed by both MMAs, superficial temporal arteries (STAs) and occipital arteries (OAs) and drained into the occluded SSS retrograde fashion, then mark-ed reflux to bilateral superficial cortical veins. There was no feeder from both internal carotid arteries. Because the SSS was occluded at the posterior one third, most cerebral venous outflow was drained into deep venous system through internal cerebral vein and straight sinus to transverse sigmoid sinus (Fig. 2). These dAVFs were classified as type IIa+IIb according to Cognard et al.1).

Bottom Line: The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux.Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough.Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

ABSTRACT
A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

No MeSH data available.


Related in: MedlinePlus