Transvenous Embolization of Venous Pouch Alone for the Treatment of Cavernous Dural Arteriovenous Fistula

Abstract

The treatment of cavernous sinus dural arteriovenous shunts (dAVS’s) with multiple feeders has been a challenge to neurosurgeons. A patient was referred to our department for the treatment of the symptomatic unilateral cavernous dAVS’s, which had a venous pouch within the cavernous sinus, toward which all multiple feeding arteries converge. The patient was successfully treated by the coil placement only within the venous pouch draining all shunts without any complications. Though not all cases of cavernous dAVS’s have the venous pouch, a thorough and careful assessment on the pre- and intraoperative digital substraction angiography monitoring should be made to find the venous pouch or shunt point draining all shunts. Transvenous embolization of the venous pouch alone is an effective and safe method offering a higher rate of curing the shunt as well as avoiding complications associated with the complete coil packing of the entire affected sinus in the treatment of cavernous dAVS’s with the venous pouch.