TRANSVENOUS EMBOLIZATION OF DURAL CAROTICOCAVERNOUS FISTULAS - TECHNICAL CONSIDERATIONS

Sixteen patients with symptomatic dural caroticocavernous fistulae wer e treated by transvenous embolization, via the jugular vein and inferi or petrosal sinus. The fistula was occluded by thrombogenic coils. Com plete resolution of symptoms and signs was achieved in 14 patients, an d complete angiographic resolution was also obtained in 14 patients. F ailures to achieve angiographic cure were attributed to failure to rea ch the fistula within the cavernous sinus precisely. Factors which mak e placement of the catheter at the fistula difficult are trabeculae wi thin the cavernous sinus, a specific configuration of the superior oph thalmic vein and venous thrombosis. To improve the efficacy of transve nous embolization, every possible venous route to the cavernous sinus therefore should be tried, to facilitate reaching the fistula and the possibility of transvenous embolization should not be thwarted by veno us thrombosis.