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Contralateral transvenous approach and embolization with 360° guglielmi detachable coils for the treatment of cavernous sinus dural fistula.

Zenteno M, Jorge SF, Rafael MS, Raphael AH, Gabriel AC, Ángel L - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis.A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity.The endovascular management of these lesions is currently possible with excellent results.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroradiology and Endovascular Therapy, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Tlalpan, México, Mexico.

ABSTRACT
carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis. They are clinically characterized by ophthalmological symptoms and pulsatile tinnitus. A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity. Caotid-cavernous fistula wes diagnosed, for the technical difficulty inherent in the case was made a contralateral transvenous approach and embolization with 360° GDG coils, with successful evolution of the patient. The endovascular management of these lesions is currently possible with excellent results.

No MeSH data available.


Related in: MedlinePlus

Fistula management by contrast injection through arterial approach, where there are visualized the tributary vessels (a, thick arrow) and venous embolization. The distal end of the guide catheter was fixed at the level of the internal jugular vein (a, b and c: Arrowhead), and through this was passed a microcatheter that coursed the inferior petrosal sinus, the right cavernous and intercavernous sinuses (a-d and f, thin arrows). The distal end of the microcatheter was placed in the left cavernous sinus (b, arrow) and was started the coils placing and releasing (c-f, Star). By the end of angiographic embolization, meningeal vessels were observed, with no communication with the cavernous sinus (e, thick arrow)
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Figure 5: Fistula management by contrast injection through arterial approach, where there are visualized the tributary vessels (a, thick arrow) and venous embolization. The distal end of the guide catheter was fixed at the level of the internal jugular vein (a, b and c: Arrowhead), and through this was passed a microcatheter that coursed the inferior petrosal sinus, the right cavernous and intercavernous sinuses (a-d and f, thin arrows). The distal end of the microcatheter was placed in the left cavernous sinus (b, arrow) and was started the coils placing and releasing (c-f, Star). By the end of angiographic embolization, meningeal vessels were observed, with no communication with the cavernous sinus (e, thick arrow)

Mentions: Therefore, to access this sinus we used the femoral vein, traveling through the internal jugular vein, inferior petrosal sinus and right cavernous sinus respectively, to access to the intercavernous sinus and posteriorly set the distal end of the microcatheter at the level of the left cavernous sinus [Figure 5]. We removed the microwire and proceeded to coil embolization of the left cavernous sinus.


Contralateral transvenous approach and embolization with 360° guglielmi detachable coils for the treatment of cavernous sinus dural fistula.

Zenteno M, Jorge SF, Rafael MS, Raphael AH, Gabriel AC, Ángel L - Asian J Neurosurg (2015 Jan-Mar)

Fistula management by contrast injection through arterial approach, where there are visualized the tributary vessels (a, thick arrow) and venous embolization. The distal end of the guide catheter was fixed at the level of the internal jugular vein (a, b and c: Arrowhead), and through this was passed a microcatheter that coursed the inferior petrosal sinus, the right cavernous and intercavernous sinuses (a-d and f, thin arrows). The distal end of the microcatheter was placed in the left cavernous sinus (b, arrow) and was started the coils placing and releasing (c-f, Star). By the end of angiographic embolization, meningeal vessels were observed, with no communication with the cavernous sinus (e, thick arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352642&req=5

Figure 5: Fistula management by contrast injection through arterial approach, where there are visualized the tributary vessels (a, thick arrow) and venous embolization. The distal end of the guide catheter was fixed at the level of the internal jugular vein (a, b and c: Arrowhead), and through this was passed a microcatheter that coursed the inferior petrosal sinus, the right cavernous and intercavernous sinuses (a-d and f, thin arrows). The distal end of the microcatheter was placed in the left cavernous sinus (b, arrow) and was started the coils placing and releasing (c-f, Star). By the end of angiographic embolization, meningeal vessels were observed, with no communication with the cavernous sinus (e, thick arrow)
Mentions: Therefore, to access this sinus we used the femoral vein, traveling through the internal jugular vein, inferior petrosal sinus and right cavernous sinus respectively, to access to the intercavernous sinus and posteriorly set the distal end of the microcatheter at the level of the left cavernous sinus [Figure 5]. We removed the microwire and proceeded to coil embolization of the left cavernous sinus.

Bottom Line: carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis.A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity.The endovascular management of these lesions is currently possible with excellent results.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroradiology and Endovascular Therapy, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Tlalpan, México, Mexico.

ABSTRACT
carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis. They are clinically characterized by ophthalmological symptoms and pulsatile tinnitus. A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity. Caotid-cavernous fistula wes diagnosed, for the technical difficulty inherent in the case was made a contralateral transvenous approach and embolization with 360° GDG coils, with successful evolution of the patient. The endovascular management of these lesions is currently possible with excellent results.

No MeSH data available.


Related in: MedlinePlus