Transvenous embolization of dural arteriovenous fistula of the cavernous sinus by identifying the orifice of the occluded inferior petrosal sinus through the angle of the microguidewire

Objective

To describe that the angle of the microguidwire on lateral projection under fluoroscopic image is a prediction of cannulation of the occluded inferior petrosal sinus in the transvenous embolization of cavernous sinus dural fistulas.

Methods

From January 2018 through January 2021, 12 cavernous sinus dural fistulas with ipsilateral inferior petrosal sinus occlusion identified in 12 consecutive patients were cured by cannulation of the occluded ipsilateral inferior petrosal sinus. Clinical, radiologic and procedure data of the 12 patients were retrospectively reviewed. The angle of microguidewire between on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was measured.

Results

In the 12 patients, access via the occluded ipsilateral inferior petrosal sinus was primarily attempted as the transvenous approach. During the procedure, the angle of microguidwire on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was 117°±7°, which is very useful to confirm the cannulation of the occluded inferior petrosal sinus. Complete occlusion was achieved in all fistulas, with no procedure-related morbidity or mortality. Postprocedural symptom was improved in all patients.

Conclusion

Cannulation of an occluded inferior petrosal sinus is possible and reasonable as an initial access attempt for cavernous sinus dural fistulas. The angle of microguidwire on the lateral projection under fluoroscopic image can help to confirm the orifice of the occluded inferior petrosal sinus.