Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus

  • Deniwar, Mohamed Adel (Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwon, Boseong (Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Yunsun (Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jung Cheol (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Deok Hee (Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.10.15
  • Accepted : 2021.11.24
  • Published : 2022.09.01
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Abstract

Objective : Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. Methods : In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. Results : Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. Conclusion : The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.

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References

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