Cavernous Sinus Dural Fistulae Treated by Transvenous Approach through the Facial Vein: Report of Seven Cases and Review of the Literature

Dural AVF of the right cavernous sinus in a 45-year-old woman.

A, Lateral view angiogram of the right common artery, obtained before embolization, shows a dural AVF. The inferior petrosal sinus is thrombosed at the level of its inferior portion.

B, Oblique view angiogram of the internal carotid artery, obtained before embolization, shows a dural AVF with predominant venous drainage toward the SOV and facial vein (arrow).

C, Anteroposterior view angiogram of the external carotid artery, obtained before embolization, shows a dural AVF with predominant venous drainage toward the SOV.

D, Lateral view road map, obtained by injecting the internal carotid artery, shows intermediate steps of the retrograde catheterization through the facial vein up to the cavernous sinus. The tip of the microcatheter is in the angular vein. Facial vein (thick arrow), angular vein (short thin arrow), SOV inferior root (double arrows), SOV superior root (long thin arrow).

E, Oblique view road map, obtained by injecting the external carotid artery, shows that the microcatheter (with the microguidewire) is in the angular vein before the SOV superior root, which is elongated and dilated. Facial vein (thick arrow), angular vein (short thin arrow), SOV inferior root (double arrows), SOV superior root (long thin arrow).

F, Lateral view road map, obtained by injecting the internal carotid artery, shows intermediate steps of the retrograde catheterization through the facial vein up to the cavernous sinus. The microcatheter reaches the posterior part of the cavernous sinus, while the microguidewire is pushed up to the thrombosed inferior petrosal sinus.

G, After positioning of coils within the cavernous sinus, lateral view angiogram of the right internal carotid artery shows complete occlusion of the dural fistula.

H, After positioning of coils within the cavernous sinus, lateral view angiogram of the external carotid artery shows complete occlusion of the dural fistula.