Dural Cavernous Sinus Fistulas (eBook)

10 year experience in Interventional Neuroradiology, consultant for INR at Charité, HU, Berlin

Foreword 6
Preface 7
Table of Contents 9
Glossary 11
1 Introduction 13
References 14
2 Historical Considerations 15
2.1 Arteriovenous Fistula and Pulsating Exophthalmos 15
2.2 Angiography 18
2.3 Therapeutic Measures 21
2.4 Embolization 22
References 23
3 Anatomy of the Cavernous Sinus and Related Structures 26
3.1 Osseous Anatomy 26
3.1.1 Orbit 29
3.2 Anatomy of the Dura Mater and the Cranial Nerves 31
3.2.1 Autonomic Nervous System 32
3.3 Vascular Anatomy 32
3.3.1 Arterial Anatomy 32
3.3.1.1 Internal Carotid Artery 32
3.3.1.1.1 Branches of the ICA Branches of the Cavernous Segment 34
Meningohypophyseal Trunk (MHT) 34
The inferolateral trunk (ILT) 35
Ophthalmic Artery 37
Ethmoidal Arteries 39
3.3.1.2 External Carotid Artery 40
3.3.1.2.1 Ascending Pharyngeal Artery 40
3.3.1.2.2 Internal Maxillary Artery 40
3.3.1.2.3 Middle Meningeal Artery 41
3.3.1.2.4 Accessory Meningeal Artery 41
3.3.2 Venous Anatomy 42
3.3.2.1 The Cavernous Sinus, Receptaculum, Sinus Caroticus (Rektorzik), Con. uens Sinuum Anterius, Sinus Spheno-Parietale (Cruveilhier), Cavernous Plexus, Lateral Sellar Compartment 42
3.3.2.1.1 Embryology 42
3.3.2.1.2 Anatomy and Topography 42
3.3.2.2 Tributaries of the Cavernous Sinus (Afferent Veins) 47
Orbital Veins 47
Superior Ophthalmic Vein 47
Inferior Ophthalmic Vein 48
Central Retinal Vein (No Direct CS Tributary) 49
Superficial Middle Cerebral Vein, Sylvian Vein 49
Uncal Vein, Uncinate Vein 50
Sphenoparietal sinus (Breschet), Sinus alae parvae, Sinus sphenoidales superior (Sir C. Bell) 50
Intercavernous Sinus, Sinus intercavernosus, Sinus circularis (Ridley), Sinus ellipticus, Sinus coronarius, Sinus clinoideus (Sir C. Bell), Sinus transversus sellae equinae (Haller) 50
Meningeal Veins 51
Veins of the Foramen Rotundum, Emissary Vein 51
3.3.2.3 Drainage of the Cavernous Sinus (Efferent Veins) 51
Superior Petrosal Sinus, Sinus petrobasilaris (Langer), Sinus tentorii lateralis (Weber), Sinus petrosus super. cialis 51
Inferior Petrosal Sinus, Sinus petrosus profundus, Sinus petro-occipitalis superior (Trolard) 51
Venous Plexus of the Hypoglossal Canal, Anterior Condylar Vein 53
Posterior Condylar Vein 53
Lateral Condylar Vein 53
Inferior Petroclival Vein 53
Petro-occipital Sinus, Sinus petro-occipitalis inferior, petro-occipital vein (Padget) 53
Transverse Occipital Sinus (Doyen) 53
Basilar Plexus (Virchow) 53
Marginal Sinus 53
Internal Carotid Artery Venous Plexus, Sinus Venous Caroticus (Haike), Carotid Sinus, Pericarotid Plexus 54
Foramen Ovale Plexus (Trigeminal Sinus), Sphenoid Emissary, “Rete” of the Foramen Ovale 54
Vein of the Sphenoid Foramen (Foramen Venosum, Foramen of Vesalius) 54
Foramen Lacerum Plexus 54
Pterygoid Plexus 54
3.3.2.4 Other Veins of Importance for the CS Drainage or for Transvenous Access to the CS 55
Facial Vein 55
Frontal Vein 55
Angular Vein 55
Middle Temporal Vein 55
Internal Jugular Vein 55
The External Jugular Vein 56
Vertebral Vein, Vertebral Artery Venous Plexus 56
Deep Cervical Vein 56
Anterior Condylar Con. uent (Con. uens Condyloideum Anterius, Trolard 1868) 57
References 57
4 Classification of Cavernous Sinus Fistulas (CSFs) and Dural Arteriovenous Fistulas (DAVFs) 62
Introduction 62
4.1 Anatomic Classification 62
4.1.1 Dural Arteriovenous Fistulas (DAVFs) 62
4.1.2 Cavernous Sinus Fistulas (CSFs) 65
4.2 Etiologic Classification 71
4.3 Hemodynamic Classification 71
References 73
5 Etiology, Prevalence and Natural History of Dural Cavernous Sinus Fistulas (DCSFs) 75
Introduction 75
5.1 Etiology and Pathogenesis of Type A Fistulas 76
5.2 Etiology and Pathogenesis of Type B–D Fistulas 77
5.2.1 Pregnancy 78
5.2.2 Hormonal Factors 78
5.2.3 Thrombosis 79
5.2.4 Venous Hypertension 82
5.2.5 Trauma 82
5.2.6 Embolization 83
5.2.7 Congenital 83
5.2.8 Other Potential Factors 84
5.2.9 Various 85
5.3 Prevalence 86
5.3.1 Natural History 88
References 89
6 Neuro-Ophthalmology in Dural Cavernous Sinus Fistulas (DCSFs) 94
Introduction 94
6.1 Extraorbital Ocular Symptoms 95
6.1.1 Orbital Pain 95
6.1.2 Cranial Nerve De. cits and Ophthalmoplegia 96
6.2 Orbital Symptoms 96
6.2.1 Exophthalmos 97
6.2.2 Conjunctival Engorgement and Chemosis 97
6.2.2.1 Retinal Hemorrhage 98
6.2.3 Corneal Damage 98
6.2.4 Orbital Bruit 99
6.2.5 Puls-synchronous Pulsation of the Eyelid and Bulb 100
6.2.6 Secondary Glaucoma and Visual Loss 100
6.3 Other and Neurological Symptoms 100
6.4 Differential Diagnosis 101
References 103
7 Radiological Diagnosis of DCSFs 106
7.1 Non-invasive Imaging Techniques 106
7.1.1 CT and MRI 106
7.1.2 Doppler and Carotid Duplex Sonography 115
7.2 Intra-arterial Digital Subtraction Angiography (DSA) 118
7.2.1 Introduction 118
7.2.2 Technique 118
7.2.3 Angiographic Protocol for DCSFs 119
7.2.4 Angiographic Anatomy of the Cavernous Sinus 120
7.2.5 Flat Detector Technology in Neuroangiography 148
7.2.6 Rotational Angiography and 3D-DSA 148
7.2.6.1 Dual Volume Technique (DVT) 152
7.2.6.2 Angiographic Computed Tomography (ACT), DynaCT (Siemens), C-arm Flat Detector CT (FD-CT), Flat Panel CT (FP-CT) or Cone Beam CT 152
7.2.6.3 Image Post-Processing 155
7.2.6.4 3D Studies of the Cavernous Sinus Region 157
References 193
8 Endovascular Treatment 198
8.1 Techniques of Transvenous Catheterization 198
8.1.1 Inferior Petrosal Sinus Approach 200
8.1.2 Alternative Approaches to the Cavernous Sinus 205
8.1.2.1 Transfemoral Superior Ophthalmic Vein Approach 205
8.1.2.2 Transcutaneous Superior Ophthalmic Vein Approach 205
8.1.2.3 Transorbital Puncture of the Superior or Inferior Ophthalmic Vein 206
8.1.3 Other Techniques 206
8.2 Embolic Agents 206
8.2.1 Polyvinyl Alcohol (PVA) and Embospheres 206
8.2.2 Stainless Steel Coils 207
8.2.2.1 Platinum (Non-detachable) Pushable Microcoils 207
8.2.2.2 Detachable Platinum Coils 208
8.2.2.3 HydroCoils 211
8.2.3 Liquid Embolic Agents: Cyanoacrylates (N-butyl-cyanoacrylate, Acrylic Glue, HistoacrylTM, Tru. llTM n-BCA, GlubranTM) 213
8.2.4 Onyx™ (Ethylene-Vinyl Alcohol Copolymer) 214
8.2.5 Stents 215
8.3 Results of Transvenous Embolizations 217
8.3.1 Approaches (Benndorf et al. 2004) 217
8.3.2 Angiographic and Clinical Outcome 217
8.3.3 Cases Reports 218
8.3.3.1 Case Report I: Approach via the Thrombosed IPS 218
8.3.3.2 Case Report II: Cross-Over Approach via the IPS 218
8.3.3.3 Case Report III: Approach via the Thrombosed Cavernous Sinus 224
8.3.3.4 Case Report IV: Transfemoral Cross-Over Approach via the Facial Vein and SOV 224
8.3.3.5 Case Report V: Transophthalmic Approach (Cannulation) via the SOV 229
8.3.3.6 Case Report VI: Direct Puncture of the SOV 229
8.3.3.7 Case Report VII: Direct Puncture of the Sylvian Vein After Craniotomy 234
8.3.4 Case Illustrations 234
8.4 Discussion of Transvenous Occlusions 237
8.4.1 Approaches 237
8.4.1.1 IPS Approaches 237
8.4.1.2 Thrombosed Cavernous Sinus 240
8.4.1.3 Transfemoral Facial Vein/Superior Ophthalmic Vein Approach 241
8.4.1.4 Approaches via the Middle Temporal Vein or the Frontal Vein 242
8.4.1.5 Transfemoral Superior Petrosal Sinus Approach 243
8.4.1.6 Transfemoral Pterygoid Plexus Approach (PP Approach) 243
8.4.1.7 Transfemoral Cortical Vein Approach 243
8.4.1.8 Transcutaneous SOV Approach 244
8.4.1.9 Transorbital SOV Approach 245
8.4.1.10 Direct Puncture of the Foramen Ovale 246
8.4.1.11 Direct Puncture of the CS via the SOF 246
8.4.1.12 Sylvian Vein Approach: Combined Surgical/Endovascular Treatment 260
8.4.2 Embolic Materials 261
8.4.2.1 Particles 261
8.4.2.2 Coils 261
HydroCoils (Hydrogel) 264
8.4.2.3 NBCA (HistoacrylTM, GlubranTM, TrufillTM) 265
8.4.2.4 Ethylene-Vinyl Alcohol Copolymer (OnyxTM) 266
8.4.2.5 Stents and Covered Stents 268
8.4.3 Anatomic Results, Clinical Outcome and Complications of Transvenous Occlusions and Transarterial Embolizations 269
8.5 Conclusion 276
References 276
9 Alternative Treatment Options 285
9.1 Spontaneous Thrombosis 285
9.2 Manual Compression Therapy 288
9.3 Controlled Hypotension Case Report VIII 290
9.4 Radiotherapy 292
9.5 Surgery 295
References 297
10 Hemodynamic Aspects of DCSFs 301
10.1 Introduction 301
10.2 Basic Hemodynamic Principles 302
10.3 Invasive Assessment of Hemodynamics 303
10.4 Flow Velocity and Pressure Measurements in Brain AVMs and DAVFs 305
10.5 Hemodynamics and Pathophysiology in CSFs 305
10.6 Flow Velocity and Pressure Measurements in DCSFs 308
Comments 311
References 313
11 Summary 316
Subject Index 319