Impact of transvenous embolization via superior ophthalmic vein on reducing the total number of coils used for patients with cavernous sinus dural arteriovenous fistula


Although transvenous embolization (TVE) via the superior ophthalmic vein (SOV) is adopted in treating cavernous sinus dural arteriovenous fistula (CS DAVF), its effect on the coil volume is rarely understood. The purpose of the study was to investigate if there is a difference in the total number of coils used and in patient safety when comparing two access strategies. We retrospectively reviewed charts for patients with CS DAVF treated with TVE between January 2008 and March 2018. The baseline patient characteristics, details of procedure, placed coils, and clinical results were compared. A total of 42 patients with CS DAVF were treated with the inferior petrosal sinus (IPS) (n = 32) or SOV (n = 10) approach. TVE via SOV showed a high success rate of 100% (10/10) by transfemoral access. The total number (23 versus 11; P < 0.001), length (159 versus 81 cm; P = 0.003), and volume of placed coils (111 versus 46 mm3; P = 0.005) were significantly lower in patients treated via SOV. Patients treated via SOV had significantly higher initial intrasinus pressure (49 versus 59 mmHg; P = 0.022) obtained by microcatheters; however, no adverse events occurred related to elevated sinus pressure between both approaches. Procedural complications and cranial nerve palsy outcomes were not significantly different. In cases with a visualized pathway to the SOV, this approach should be preferred, in all other cases standard approach via the IPS should be used, even if it cannot be visualized.

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This report relied on the intensive perioperative management of neurosurgeons at our department. The authors would like to thank all other staff, neurosurgeons, and radiologists of our hospital.

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by A. Fujita and M. Kohta. The project was directed and supervised by T. Sasayama and E. Kohmura. The first draft of the manuscript was written by A. Fujita and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscripts.

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Correspondence to Atsushi Fujita.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Kobe University Hospital (approval number 180258).

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Fujita, A., Kohta, M., Sasayama, T. et al. Impact of transvenous embolization via superior ophthalmic vein on reducing the total number of coils used for patients with cavernous sinus dural arteriovenous fistula. Neurosurg Rev 44, 401–409 (2021).

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  • Cavernous sinus
  • Dural arteriovenous fistula
  • Facial vein
  • Superior ophthalmic vein
  • Transvenous embolization