Occlusion of a clival dural arteriovenous fistula using a novel approach through the foramen ovale

Dural arteriovenous fistulas (DAVFs) are abnormal connections between arteries and veins that are classified by location, morphology or direction of venous drainage. Treatment of DAVFs is undertaken in patients with severe symptoms or those with retrograde cortical venous drainage and/or venous ectasia. Much is written regarding the treatment of DAVFs involving the transverse sigmoid sinuses, cavernous sinus and tentorium, but little is written concerning the treatment of clival DAVFs. We demonstrate a novel transforaminal percutaneous approach through the foramen ovale as a viable method to occlude a clival vein. Specialised software was used to create a safe trajectory to the DAVF via the foramen ovale. The patient then underwent successful occlusion of the clival DAVF, thus further increasing the neurointerventionalist's armamentarium when attempting to treat difficult to reach clival DAVFs.

[1]  Lei Feng,et al.  Occlusion of a clival dural arteriovenous fistula using a novel approach through the foramen ovale , 2012, BMJ Case Reports.

[2]  G. Pride,et al.  Dural Arteriovenous Fistulas: Review of Imaging Findings and Endovascular Treatment Strategies , 2011 .

[3]  R. Tubbs,et al.  Regional vascular relationships to the foramen ovale: an anatomical study with application to approaches to the external skull base with an emphasis on transcutaneous procedures for the treatment of trigeminal neuralgia. , 2010, Journal of neurosurgery.

[4]  G. Duckwiler,et al.  Transarterial embolization of clival dural arteriovenous fistulae using liquid embolic agents. , 2008, Neurosurgery.

[5]  I. Tekdemir,et al.  Review of complications due to foramen ovale puncture , 2007, Journal of Clinical Neuroscience.

[6]  S. Inci,et al.  Treatment of a Superior Sagittal Sinus Dural Arteriovenous Fistula with Onyx: Technical Case Report , 2006, Neurosurgery.

[7]  M. Piotin,et al.  Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note , 2006, Neuroradiology.

[8]  N. Tanriover,et al.  Microsurgical Anatomy of the Dural Arteries , 2005, Neurosurgery.

[9]  S. Matsumoto,et al.  Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[10]  K. Mori,et al.  Dural arteriovenous fistula of the transverse sinus with concomitant ipsilateral meningioma , 2003, Acta Neurochirurgica.

[11]  H. Woo,et al.  Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. , 2003, Journal of neurosurgery.

[12]  T. Kawase,et al.  Meningovenous Structures of the Petroclival Region: Clinical Importance for Surgery and Intravascular Surgery , 2002, Neurosurgery.

[13]  M. Han,et al.  Clinical characteristics of dural arteriovenous fistula , 2002, Journal of Clinical Neuroscience.

[14]  M. Miyajima,et al.  Successful transarterial glue embolisation by wedged technique for a tentorial dural arteriovenous fistula presenting with a conjunctival injection , 2001, Neuroradiology.

[15]  G. Duckwiler,et al.  Dural arteriovenous fistula in children: endovascular treatment and outcomes in seven cases. , 2001, AJNR. American journal of neuroradiology.

[16]  Y. Tu,et al.  Transarterial embolisation of complex cavernous sinus dural arteriovenous fistulae with low-concentration cyanoacrylate , 2000, Neuroradiology.

[17]  R. Higashida,et al.  Diagnosis and treatment of dural arteriovenous fistulas. , 1998, Neuroimaging clinics of North America.

[18]  M. Sindou,et al.  Percutaneous biopsy of cavernous sinus tumors through the foramen ovale. , 1997, Neurosurgery.

[19]  R. Higashida,et al.  Dural arteriovenous fistulas of the marginal sinus. , 1997, AJNR. American journal of neuroradiology.

[20]  K. terBrugge,et al.  The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. , 1996, Journal of neurosurgery.

[21]  L. Pierot,et al.  Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. , 1995, Radiology.

[22]  W. Shucart,et al.  A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. , 1995, Journal of neurosurgery.

[23]  I. Awad,et al.  Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. , 1990, Journal of neurosurgery.

[24]  R. Higashida,et al.  Dural arteriovenous fistulas involving the inferior petrosal sinus: angiographic findings in six patients. , 1990, AJNR. American journal of neuroradiology.

[25]  C. Mehringer,et al.  Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. , 1989, AJNR. American journal of neuroradiology.

[26]  A. Fox,et al.  Indications for treatment and classification of 132 carotid-cavernous fistulas. , 1988, Neurosurgery.

[27]  M. Bernstein,et al.  Neurological manifestations of intracranial dural arteriovenous malformations. , 1986, Journal of neurosurgery.

[28]  D. Pelz,et al.  Unusual clinical manifestations of dural arteriovenous malformations. , 1986, Journal of neurosurgery.

[29]  I. Tekdemir,et al.  Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study. , 2011, Turkish neurosurgery.

[30]  D. Bowsher.  Trigeminal neuralgia: An anatomically oriented review , 1997, Clinical anatomy.

[31]  H. Nakase,et al.  Dural arteriovenous fistula of the posterior fossa developing after surgical occlusion of the sigmoid sinus. Report of five cases. , 1996, Journal of neurosurgery.

[32]  I. Weitzner,et al.  Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. , 1982, AJNR. American journal of neuroradiology.