Dural Cavernous Sinus Fistulas: Diagnosis and Endovascular Therapy (Medical Radiology Diagnostic Imaging)

Dural cavernous sinus fistulas (DCSFs) are benign vascular diseases consisting in an arteriovenous shunt at the cavernous sinus that if misdiagnosed can lead to potentially serious ophthalmologic complications. This volume provides a complete guide to the diagnosis and minimal invasive treatment of DCSFs. After sections on anatomy and classification, etiology and pathogenesis of DCSFs, the symptomatology of the disease is described in detail. The role of modern imaging techniques in the diagnosis of DCSFs is then addressed. Digital subtraction angiography (DSA) remains the gold standard for clinical decision-making; here, full consideration is given to both, conventional 2D DSA and rotational 3D angiography. Recent technological advances in this field such as Dual Volume (DV) imaging and angiographic computed tomography (ACT) are considered as well. Due attention is further paid to the use of computed tomography, magnetic resonance imaging and ultrasound. Finally, the therapeutic management of DCSFs with emphasis on various transvenous occlusion techniques are discussed in depth. This well-illustrated volume will be invaluable to all who may encounter DCSF in their clinical practice. Cover......Page 1 Front-matter......Page 2 Title Page......Page 3 Copyright Page......Page 4 Dedication Page......Page 5 Foreword......Page 6 Preface......Page 7 Table of Contents......Page 9 Glossary......Page 11 1. Introduction......Page 13 2.1 Arteriovenous Fistula and Pulsating Exophthalmos......Page 15 2.2 Angiography......Page 18 2.3 Therapeutic Measures......Page 21 2.4 Embolization......Page 22 References......Page 23 3.1 Osseous Anatomy......Page 26 3.1.1 Orbit......Page 29 3.2 Anatomy of the Dura Mater and the Cranial Nerves......Page 31 3.3.1.1 Internal Carotid Artery......Page 32 Meningohypophyseal Trunk (MHT)......Page 34 The inferolateral trunk (ILT)......Page 35 Ophthalmic Artery......Page 37 Ethmoidal Arteries......Page 39 3.3.1.2.2 Internal Maxillary Artery......Page 40 3.3.1.2.4 Accessory Meningeal Artery......Page 41 3.3.2.1.2 Anatomy and Topography......Page 42 Superior Ophthalmic Vein......Page 47 Inferior Ophthalmic Vein......Page 48 Superficial Middle Cerebral Vein, Sylvian Vein......Page 49 Intercavernous Sinus, Sinus intercavernosus, Sinus circularis (Ridley), Sinus ellipticus, Sinus coronarius, Sinus clinoideus (Sir C. Bell), Sinus transversus sellae equinae (Haller)......Page 50 Inferior Petrosal Sinus, Sinus petrosus profundus, Sinus petro-occipitalis superior (Trolard)......Page 51 Marginal Sinus......Page 53 Pterygoid Plexus......Page 54 Internal Jugular Vein......Page 55 Deep Cervical Vein......Page 56 References......Page 57 4.1.1 Dural Arteriovenous Fistulas (DAVFs)......Page 62 4.1.2 Cavernous Sinus Fistulas (CSFs)......Page 65 4.3 Hemodynamic Classification......Page 71 References......Page 73 Introduction......Page 75 5.1 Etiology and Pathogenesis of Type A Fistulas......Page 76 5.2 Etiology and Pathogenesis of Type B–D Fistulas......Page 77 5.2.2 Hormonal Factors......Page 78 5.2.3 Thrombosis......Page 79 5.2.5 Trauma......Page 82 5.2.7 Congenital......Page 83 5.2.8 Other Potential Factors......Page 84 5.2.9 Various......Page 85 5.3 Prevalence......Page 86 5.3.1 Natural History......Page 88 References......Page 89 Introduction......Page 94 6.1.1 Orbital Pain......Page 95 6.2 Orbital Symptoms......Page 96 6.2.2 Conjunctival Engorgement and Chemosis......Page 97 6.2.3 Corneal Damage......Page 98 6.2.4 Orbital Bruit......Page 99 6.3 Other and Neurological Symptoms......Page 100 6.4 Differential Diagnosis......Page 101 References......Page 103 7.1.1 CT and MRI......Page 106 7.1.2 Doppler and Carotid Duplex Sonography......Page 115 7.2.2 Technique......Page 118 7.2.3 Angiographic Protocol for DCSFs......Page 119 7.2.4 Angiographic Anatomy of the Cavernous Sinus......Page 120 7.2.6 Rotational Angiography and 3D-DSA......Page 148 7.2.6.2 Angiographic Computed Tomography (ACT), DynaCT (Siemens), C-arm Flat Detector CT (FD-CT), Flat Panel CT (FP-CT) or Cone Beam CT......Page 152 7.2.6.3 Image Post-Processing......Page 155 7.2.6.4 3D Studies of the Cavernous Sinus Region......Page 157 References......Page 193 8.1 Techniques of Transvenous Catheterization......Page 198 8.1.1 Inferior Petrosal Sinus Approach......Page 200 8.1.2.2 Transcutaneous Superior Ophthalmic Vein Approach......Page 205 8.2.1 Polyvinyl Alcohol (PVA) and Embospheres......Page 206 8.2.2.1 Platinum (Non-detachable) Pushable Microcoils......Page 207 8.2.2.2 Detachable Platinum Coils......Page 208 8.2.2.3 HydroCoils......Page 211 8.2.3 Liquid Embolic Agents: Cyanoacrylates (N-butyl-cyanoacrylate, Acrylic Glue, HistoacrylTM, Tru. llTM n-BCA, GlubranTM)......Page 213 8.2.4 OnyxTM (Ethylene-Vinyl Alcohol Copolymer)......Page 214 8.2.5 Stents......Page 215 8.3.2 Angiographic and Clinical Outcome......Page 217 8.3.3.2 Case Report II: Cross-Over Approach via the IPS......Page 218 8.3.3.4 Case Report IV: Transfemoral Cross-Over Approach via the Facial Vein and SOV......Page 224 8.3.3.6 Case Report VI: Direct Puncture of the SOV......Page 229 8.3.4 Case Illustrations......Page 234 8.4.1.1 IPS Approaches......Page 237 8.4.1.2 Thrombosed Cavernous Sinus......Page 240 8.4.1.3 Transfemoral Facial Vein/Superior Ophthalmic Vein Approach......Page 241 8.4.1.4 Approaches via the Middle Temporal Vein or the Frontal Vein......Page 242 8.4.1.7 Transfemoral Cortical Vein Approach......Page 243 8.4.1.8 Transcutaneous SOV Approach......Page 244 8.4.1.9 Transorbital SOV Approach......Page 245 8.4.1.11 Direct Puncture of the CS via the SOF......Page 246 8.4.1.12 Sylvian Vein Approach: Combined Surgical/Endovascular Treatment......Page 260 8.4.2.2 Coils......Page 261 HydroCoils (Hydrogel)......Page 264 8.4.2.3 NBCA (HistoacrylTM, GlubranTM, TrufillTM)......Page 265 8.4.2.4 Ethylene-Vinyl Alcohol Copolymer (OnyxTM)......Page 266 8.4.2.5 Stents and Covered Stents......Page 268 8.4.3 Anatomic Results, Clinical Outcome and Complications of Transvenous Occlusions and Transarterial Embolizations......Page 269 References......Page 276 9.1 Spontaneous Thrombosis......Page 285 9.2 Manual Compression Therapy......Page 288 9.3 Controlled Hypotension Case Report VIII......Page 290 9.4 Radiotherapy......Page 292 9.5 Surgery......Page 295 References......Page 297 10.1 Introduction......Page 301 10.2 Basic Hemodynamic Principles......Page 302 10.3 Invasive Assessment of Hemodynamics......Page 303 10.5 Hemodynamics and Pathophysiology in CSFs......Page 305 10.6 Flow Velocity and Pressure Measurements in DCSFs......Page 308 Comments......Page 311 References......Page 313 11 Summary......Page 316 Subject Index......Page 319 Dural cavernous sinus fistulas (DCSFs) represent a benign vascular disease, consisting in an arteriovenous shunt at the cavernous sinus. In the absence of spontaneous resolution, the fistula may lead to eye redness, swelling, proptosis, chemosis, ophthalmoplegia and visual loss. Although modern imaging techniques have improved the diagnostic, patients with low-flow DCSFs are still misdiagnosed. These patients can get erroneously treated for infections and inflammation for months or years and are at risk of visual loss. Early and proper diagnosis helps to avoid deleterious clinical course of the disease. This volume provides a complete guide to clinical and radiological diagnosis as well as to therapeutic management of DCSF with emphasis on modern minimal invasive treatment options. It commences with an informative description of relevant anatomy. After sections on the classification, etiology and pathogenesis of DCSF, the clinical symptomatology of the disease is described in detail. The role of modern non-invasive imaging tools is then addressed with the use of computed tomography, magnetic resonance imaging and ultrasound. Intra-arterial digital subtraction angiography (DSA), although invasive, remains the gold standard and is mandatory for clinical decision-making and strategy in endovascular treatment. Hence, a throughout consideration is given to both, 2D-DSA and 3D rotational angiography, including recent technological advancements such as Dual Volume (DV) imaging and angiographic computed tomography (ACT). After a short section on arteriovenous hemodynamics, the therapeutic management of DCSFs is described in detail. In particular, various transvenous techniques, required for successful endovascular occlusion of DCSF, are discussed in depth. This well-illustrated volume will be invaluable to all who may encounter DCSF in their clinical practice A Complete Guide To The Diagnosis And Treatment Of Dural Cavernous Sinus Fistula. Includes Sections On Anatomy, Etiology And Pathogenesis. Explains The Role Of The Most Modern Imaging Techniques. Discusses The Various Transvenous Techniques For Successful Endovascular Treatment. Contains Many Informative Illustrations, Some In Color.