Dimancea Alexandru, Hasiu Anca, Pop Raoul
From the Interventional Neuroradiology Department (A.D., A.H., R.P.), Strasbourg University Hospitals, Strasbourg, France
From the Interventional Neuroradiology Department (A.D., A.H., R.P.), Strasbourg University Hospitals, Strasbourg, France.
AJNR Am J Neuroradiol. 2025 Aug 1;46(8):1645. doi: 10.3174/ajnr.A8878.
Cavernous sinus dural arteriovenous fistulas (dAVFs) are most frequently treated by a transvenous approach via the inferior petrosal sinus (IPS). However, in certain patients, the IPS is not amenable to navigation. In this technical video, we present the case of a patient with a cavernous sinus dAVF embolized by the transfemoral transfacial venous route on a failed attempt to catheterize the IPS. Preprocedural head and neck imaging was performed, documenting the facial vein draining to the internal jugular vein via the common facial vein on the side of the fistula. Embolization was accomplished without complications, with complete exclusion of the fistula. We suggest that treatment via the transfemoral transfacial venous pathway should be attempted and followed through whenever the IPS is not amenable to catheterization, on the basis of favorable preprocedural anatomy and the safety and efficacy demonstrated in several published case series.
海绵窦硬脑膜动静脉瘘（dAVF）最常通过经下岩窦（IPS）的经静脉途径进行治疗。然而，在某些患者中，无法通过IPS进行导航。在本技术视频中，我们展示了一例海绵窦dAVF患者的病例，该患者在尝试经IPS插管失败后，通过经股经面静脉途径进行了栓塞治疗。术前进行了头颈部影像学检查，记录了瘘管侧面部静脉经面总静脉引流至颈内静脉的情况。栓塞过程顺利，无并发症，瘘管完全闭塞。我们建议，只要IPS无法进行插管，基于有利的术前解剖结构以及多个已发表病例系列所证明的安全性和有效性，应尝试并采用经股经面静脉途径进行治疗。
