Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 328-332
World Neurosurgery

Technical Note
Efficacy of Cone Beam Computed Tomography in Treating Cavernous Sinus Dural Arteriovenous Fistula

https://doi.org/10.1016/j.wneu.2017.10.026Get rights and content

Background

Exact identification of feeding arteries, shunt points, and draining veins is essential in treating cavernous sinus dural arteriovenous fistula (CS dAVF). In addition to digital subtraction angiography (DSA) and 3-dimensional rotational angiography (3DRA), high-resolution cone beam computed tomography (CBCT; especially 80-kv high-resolution cone beam computed tomography) have been performed in recent years. We evaluated the efficacy of CBCT in treating CS dAVF.

Methods

Eight CS dAVFs were treated with endovascular embolization between January 2013 and December 2016. We retrospectively examined these cases regarding information from DSA, 3DRA, and CBCT with contrast medium.

Results

Although all procedures can evaluate feeding arteries, shunt points, and draining veins, CBCT can provide the best definition of feeders and their course through the bony structures and the compartment of CS. Therefore, CBCT with placed microcatheter in the CS can reveal whether the microcatheter is set at the appropriate compartment to be embolized.

Conclusions

The efficacy of CBCT in treating dAVF is illustrating the relationships among the bony structures and feeders, compartment of CS, and the position of the microcatheter. Detailed information obtained with CBCT can lead to fewer complications and more effective treatment.

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.

References (24)

  • J. Liu et al.

    Transarterial ONYX embolization of intracranial dural arteriovenous fistulas in adults

    Turk Neurosurg

    (2016)
  • V.V. Halbach et al.

    Transvenous embolization of dural fistulas involving the cav- ernous sinus

    AJNR Am J Neuroradiol

    (1989)
  • D.J. Kim et al.

    Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management

    AJNR Am J Neuroradiol

    (2006)
  • D. Roy et al.

    The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas

    Neurosurgery

    (1997)
  • T.D. Aadland et al.

    3D C-arm conebeam CT angiography as an adjunct in the precise anatomic characterization of spinal dural arteriovenous fistulas

    AJNR Am J Neuroradiol

    (2010)
  • M. Eesa et al.

    Angiographic computed tomography with selective microcatheterization in delineating surgical anatomy in the case of a dural arteriovenous fistula. Technical note

    J Neurosurg

    (2009)
  • G. Farago et al.

    Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

    Eur Radiol

    (2017)
  • T. Hiu et al.

    Efficacy of DynaCT digital angiography in the detection of the fistulous point of dural arteriovenous fistulas

    AJNR Am J Neuroradiol

    (2009)
  • A.R. Honarmand et al.

    Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas

    J Neurointerv Surg

    (2015)
  • A. Okamura et al.

    Intraoperative cone-beam computed tomography contributes to avoiding hypoglossal nerve palsy during transvenous embolization for dural arteriovenous fistula of the anterior condylar confluence

    Interv Neuroradiol

    (2016)
  • B.A. Gross et al.

    The road less traveled: transarterial embolization of dural arteriovenous fistulas via the ascending pharyngeal artery

    J Neurointerv Surg

    (2017)
  • H. Jin et al.

    Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy-a case report and review of the literature

    Interv Neuroradiol

    (2016)
  • Cited by (0)

    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.

    View full text