Article Figures & Data
Figures
- Fig 1.
Case 1.
A, Vertebral angiogram in the oblique view shows a mural-type vein of Galen malformation. The microcatheter used for coil deployment (arrowhead) was introduced through a posterior choroidal artery. The Trispan device (arrow) is deployed at the outlet of the venous pouch by retrograde venous approach. Two coils from the previous transarterial embolization procedure are depicted.
B, Angiogram obtained during embolization shows several coils detached in the venous pouch under the protection afforded by the Trispan device.
C, Final angiogram (same projection as in A) shows nearly complete obliteration of the malformation. Note a minimal residual opacification of the straight sinus (arrow).
- Fig 2.
Case 2.
A and B, Lateral right common carotid angiograms. Early phase image (A) shows the right transverse dural fistula. Parenchymal phase image (B) shows reflux in the straight, superior sagittal, and left transverse sinuses from the right transverse dural fistula. The right vein of Labbé (arrowheads in B) is opacified in a retrograde fashion.
C, Lateral venous phase angiogram obtained with a right internal carotid injection shows cerebral venous congestion. Despite retrograde flow in the right vein of Labbé (see image in B), antegrade flow (arrowheads) persists.
D, Schematic drawing of the cerebral venous drainage (left anterior oblique view) in patient 2 during embolization. The Trispan device is deployed to prevent loops of coils from being positioned in front of the right vein of Labbé.
E and F, Lateral angiograms obtained with a right common carotid injection 3 months after endovascular treatment. Arterial phase image (E) depicts cure of the right transverse dural fistula. Venous phase image (F) shows improvement in cerebral venous drainage and antegrade flow in the right vein of Labbé (arrowheads).
Tables
Case No./ Patient Sex, Age Pathologic Findings Treatment Result 1/M, 10 mo Macrocephalus. No cardiac failure. Vein of Galen malformation diagnosed in utero. Two sessions of arterial and venous embolization with coils and glue. Trispan device deployed at the outlet of the venous pouch to prevent coil migration. No complication related to treatment. Fistula almost closed. Normal development (at 6-mo follow-up). Cranial overgrowth reduced. Control angiography with embolization if necessary was scheduled. 2/F, 84 y Subarachnoid hemorrhage. Right transverse sinus dural fistula with reflux in the superior sagittal sinus and cerebral venous congestion. Benign left sigmoid dural fistula without reflux. Transvenous occlusion of the right transverse sinus with coils. Trispan deployed just distal to the confluence of a right ambivalent vein of Labbé to avoid coil migration and occlusion of the outlet of the vein of Labbé. No treatment related complication. Cure of the right transverse fistula. Marked improvement of the cerebral venous drainage and congestion. Left fistula unchanged. 3/F, 47 y Subarachnoid hemorrhage. Complex dural fistula of the vein of Galen region with deep cerebral venous reflux. Arterial embolization via meningeal branches with coils and glue to reduce the shunt. Transvenous occlusion of a deep cerebral venous pouch draining the fistula. Two Trispan devices used to prevent coil migration outside the pouch to the straight sinus. No complication related to treatment. Good recovery. Fistula dramatically reduced and transformed into a benign type (no cerebral venous reflux) at 3-mo follow-up angiography. 4/F, 10 y Multiple, very high-flow complex and evolving dural fistulas of the left transverse, torcular, and right sigmoid sinuses. Left jugular vein occluded. Right jugular vein stenotic at the foramen. Increasing headaches. Four endovascular treatments. Intraventricular hemorrhage without sequela 2 wk prior to latest treatment. Surgical exposure and direct puncture of the right transverse sinus. Occlusion of the straight sinus and superior sagittal sinus with balloons to disconnect fistula from cerebral venous drainage. Trispan device deployed via right jugular vein to prevent coil migration. Coils and glue in the left transverse sinus and torcular. No technical complication. Left transverse fistula cured. Torcular fistula dramatically reduced. Right sigmoid sinus fistula unchanged. Cerebellar ataxia and dysphagia after embolization unexplained (MR imaging findings unchanged). Complete recovery within 10 d.
