J Cerebrovasc Endovasc Neurosurg.  2021 Dec;23(4):348-353. 10.7461/jcen.2021.E2021.05.008.

Transvenous injection of n-butyl 2-cyanoacrylate to obliterate the pathologic cavernous sinus as a salvage technique for incompletely obliterated complex cavernous sinus dural arteriovenous fistula after transvenous coil embolization

• Jung JY
• Lee JY

• KMID: 2523893
• DOI: http://doi.org/10.7461/jcen.2021.E2021.05.008

Abstract

A Barrow type D of complex cavernous sinus dural arteriovenous fistula (CS-dAVF) was completely obliterated by using coils, n-butyl 2-cyanoacrylate (NBCA) and Onyx via transvenous approach. Especially in this case, after transvenous coil embolization of the pathologic cavernous sinus (CS), transvenous injection of NBCA was done to obliterate residual shunts recruited into CS. The complex CS-dAVF was completely obliterated without periprocedural complications. Transvenous injection of NBCA could be considered as a feasible option for obliteration of pathologic CS in a case of incompletely obliterated complex CS-dAVF after transvenous coil embolization.

Keyword

‌Cavernous sinus; Dural arteriovenous fistula; n-butyl 2-cyanoacrylate; Onyx

Figure

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  Fig. 1. Diagnostic cerebral angiogram of a Barrow type D of complex cavernous sinus dural arteriovenous fistula. (A) Right external carotid angiogram. (B) Left external carotid angiogram. (C) Right internal carotid angiogram. (D) Left internal carotid angiogram.

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  Fig. 2. (A) Native image demonstrating an Onyx cast in the intercavernous sinus (arrow) and multiple fine feeders originating from the left ICA and ECA (arrowheads). (B) Post-embolization native image (working view) showing coil mass in the pathologic cavernous sinus, and NBCA casted in the right superior ophthalmic vein (arrow) and multiple fine feeders (arrow heads) originating from the right ECA and ICA.

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  Fig. 3. Post-embolization of the fistula without residual shunt. (A) Right external carotid angiogram. (B) Left external carotid angiogram. (C) Right internal carotid angiogram. (D) Left internal carotid angiogram.

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