Transvenous embolization of cavernous sinus dural arteriovenous fistulas with Onyx-18 and coils via unopacified inferior petrosal sinus approach

CHEN Shengpan; YE Ming; ZHANG Peng; LI Meng; ZHANG Hongqi; LING Feng

Abstract：Objective The curative effect of transvenous embolization of cavernous sinus dural arteriovenous fistulas (CSDAVF) with Onyx-18 and coils via unopacified inferior petrosal sinus approach is discussed and the success rate of exploration and catheterization of unopacified inferior petrosal sinus are investigated .Methods Clinical data and radiographic records of 44 patients who underwent endovascular emboliztion of CSDAVF via unopacified inferior petrosal sinus approach using Onyx-18 and coils between January 2008 and October 2014 in the Neurosurgery Department of Xuanwu Hospital were analyzed retrospectively .Results The femoral vein-inferior petrosal sinus approach was successful performed in 40 of 44 patients, and the success rate of exploration and catheterization of unopacified inferior petrosal sinus was 90.9%.Because of the failure of the exploration of inferior petrosal sinus, 4 cases switched to other embolization pathways .Immediate angiographic results after endovascular embolization showed complete occlusion in 43 of 44 patients (97.7%) and near-complete occlusion in 1 patient.The bradycardic reflex was occurred in 2 patients during operation, and the complication of ipsilateral abducens nerve palsy was occurred in 3 patients post-operation.The DSA showed the fistulae were complete occlusion and clinical symptoms were cured in 42 patients (95.4%) and improved in 1 patient in the post-operative follow-up.ConclusionThe inferior petrosal sinus approach is the first choice for embolization of the CSDAVF with Onyx-18 and coils with a high rate of completing occlusion.Grasping the anatomy of the inferior petrosal sinus is the key for the exploration with a high success rate. Much attention should be paid to the decrease of incidence of complications and a proper management of the post-operative problems.