gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Neurosurgical options for treatment of cavernous sinus dural AVF

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  • corresponding author M. Ezura - Department of Neuroendovascular Therapy, Tohoku University
  • A. Takahashi - Department of Neuroendovascular Therapy, Tohoku University
  • Y. Matsumoto - Department of Neuroendovascular Therapy, Kohnan Hospital

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.05.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc116.shtml

Published: May 8, 2006

© 2006 Ezura et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Although standard treatment of cavernous sinus dural arteriovenous fistula (AVF) is transvenous coil embolization, neurosurgical approach is occasionally indispensable in certain situation. We review our treatment of cavernous sinus dural AVF and study the role of neurosurgical options for the treatment of cavernous sinus dural AVF.

Methods: We treated 131 cases of cavernous sinus dural AVF in the last 12 years. Transfemoral inferior petrosal sinus (IPS) approach was initially tried in all the cases. The IPS approach was successful in 98 cases. A transfemoral facial vein approach was performed in 3 cases. A neurosurgical approach was performed in the remaining 30 cases. These are the object of this study.

Results: Transfemoral inferior petrosal sinus (IPS) approach was used first in all the cases. The neurosurgical approach followed if the IPS approach failed. A direct superior orbital vein approach was performed in 27 cases, and adirect Sylvian vein approach was used in 3 cases. A direct Sylvian approach was performed using a small craniotomy under general anesthesia. The cavernous sinus dural AVF was cured in all 30 cases. Complications were observed in 2 cases. One was an oculomotor palsy due to over-packing and one was posterior cerebral artery occlusion due to a diagnostic angiogram.

Conclusions: A neurosurgical approach is occasionally indispensable and very useful for the treatment of cavernous sinus dural AVF if the IPS approach is impossible.