A case of cavernous sinus dural arteriovenous fistula treated with superior ophthalmic vein approach via the facial vein: usefulness of triple coaxial catheter system

Abstract

● Abstract ● Objective: We report a case of cavernous sinus dural arteriovenous fistula (CdAVF) successfully treated using a triple coaxial catheter system for a transfemoral superior ophthalmic vein (SOV) approach via the facial vein. Case presentation: A 50-year-old woman presented with left chemosis and exophthalmos. Angiograms showed the left CdAVF draining into the internal jugular vein from the SOV via the facial vein. Since the cavernous sinus (CS) was inaccessible from the left occluded inferior petrosal sinus, we tried to access the CS with a SOV approach via the facial vein. The triple coaxial catheter system was used for the long and tortuous transfacial venous route. The triple coaxial catheter system consisted of a 6Fr guiding catheter, a 4Fr guiding catheter, and a microcatheter. These catheters were connected with hemostasis valves to each other. The microcatheter was successfully navigated into the CS compartment containing a fistulous point. Packing of the compartment with coils resulted in complete occlusion of the fistula. Conclusion: The triple coaxial catheter system provides additional length and support for distal navigation of the microcatheter in CdAVF embolization via a long and tortuous transfacial venous route.