Technical NoteEfficacy of Cone Beam Computed Tomography in Treating Cavernous Sinus Dural Arteriovenous Fistula
Introduction
Endovascular transvenous approaches are usually performed to treat cavernous sinus (CS) dural arteriovenous fistula (dAVF).1, 2, 3 Exact identification of feeding arteries, shunt points and draining veins are essential in planning of the procedures. Digital subtraction angiography (DSA) and 3-dimensional rotational angiography (3DRA) have been used commonly. Several reports say that cone beam computed tomography (CBCT) is useful in evaluating cranial and spinal dAVF.4, 5, 6, 7, 8, 9
In this study, we report further image assessment including the compartments of CS, intraosseous feeding arteries, and intraoperative location of microcatheter, which can lead to fewer complications and more effective treatment.
Section snippets
Methods
Between January 2013 and September 2016, 8 patients with CS dAVF were admitted to our hospital. They underwent DSA, 3DRA, and CBCT with contrast media and a flat-panel detector biplane angiography unit (Allura Clarity; Philips Medical Systems, Eindhoven, the Netherlands). We usually use the mode of 80-kv high-resolution cone beam computed tomography (80kv HRCT) to obtain strong contrast between bones and feeding arteries. We examined the efficacy of CBCT compared with DSA and 3DRA, especially
Results
Patient characteristics are described in the Table 1. All patients but one were female. Mean age at treatment was 72.4 years (range, 66–78 years). Although only patients 2 and 6 had cortical venous reflux, all cases were symptomatic. All patients underwent TVE, but patient 4 had got spontaneous thrombosis during the procedure without embolic materials. In all cases, CBCT provided feeding arteries, shunt points, and draining veins more clearly than DSA and 3DRA did. Especially, CBCT could
Discussion
Although transarterial embolization has been reported in the literature,10, 11, 12, 13, 14 transvenous approaches are usually performed when treating CS dAVF.1, 2, 3 Various approach routes are known other than inferior petrosal sinus, such as superior petrosal sinus,15 direct superior ophthalmic vein,2, 16 transfacial vein,2 and trans-contralateral intercavernous sinus.2 In addition to the obliteration of reflux to the cortical veins and SOVs, the mainstream of treatment has been sinus packing.
Conclusion
Compared with traditional DSA and 3DRA, CBCT can provide more precise evaluation of feeding arteries and shunt points of CS dAVF. In addition, CBCT can exclusively evaluate the relationship among shunt points, compartments of CS including the cranial nerve, and the location of the microcatheters. This information may make it possible to achieve precise obliteration of shunt points and to reduce cranial nerve palsy.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.