Endoscopic endonasal transsphenoidal Onyx embolization of a paracavernous dural arteriovenous fistula

J Neurointerv Surg. 2023 Oct;15(10):1055. doi: 10.1136/jnis-2022-019971. Epub 2023 Mar 21.

Abstract

Paracavernous dural arteriovenous fistulas (pdAVFs) are extremely rare and can mimic carotid cavernous fistulas (CCFs) in both clinical presentation and imaging characteristics. Access to the venous pouch often presents the greatest challenge in the treatment of pdAVFs. Here we present a novel access technique utilizing an endoscopic endonasal transsphenoidal approach, where we directly puncture the venous pouch under both stereotactic guidance and endoscopic visualization, thereby completely embolizing a pdAVF with no alternate access (video 1). neurintsurg;15/10/1055/V1F1V1Video 1Technical video demonstrates the complete embolization of a pdAVF using an endoscopic endonasal transsphenoidal approach.

Keywords: Fistula; Liquid Embolic Material; Technique.

MeSH terms

  • Carotid-Cavernous Sinus Fistula* / therapy
  • Cavernous Sinus*
  • Central Nervous System Vascular Malformations* / diagnostic imaging
  • Central Nervous System Vascular Malformations* / surgery
  • Dimethyl Sulfoxide / therapeutic use
  • Embolization, Therapeutic* / methods
  • Humans
  • Polyvinyls / therapeutic use
  • Treatment Outcome
  • Veins

Substances

  • Polyvinyls
  • Dimethyl Sulfoxide