Transvenous embolisation via an occluded inferior petrosal sinus for cavernous sinus dural arteriovenous fistulas

Abstract

Aim of the study: We retrospectively searched for cases of transvenous embolisation for cavernous sinus dural arteriovenous fistulas. Materials and methods: Twenty-five cases underwent transvenous embolisation via the inferior petrosal sinus (IPS). IPS was probed using a standard 0.035-inch guidewire for microcatheter navigation, which was successful in all cases. Results: IPS was occluded in 17 cases (68%). Only one case experienced a complication, where the approach was changed to the contralateral side because of internal jugular vein injury. The relationship between the external auditory canal and the IPS route was reviewed in 18 cases using digital angiography (lateral view). The guidewire passed across, above, or below the external auditory canal in 10 (56%), six (33%), and two (11%) cases, respectively. Clinical implications: No previous reports have analysed the relationship between the external auditory canal and the IPS route. We present a safe and successful technique for approaching the cavernous sinus via the IPS.