Dural Cavernous Sinus Fistulas: Diagnosis and Endovascular Therapy (Medical Radiology Diagnostic Imaging)

✍ Scribed by Goetz Benndorf

Year: 2009
Tongue: English
Leaves: 325
Edition: 1
Category: Library

No coin nor oath required. For personal study only.

✦ Synopsis

Dural cavernous sinus fistulas (DCSFs) are benign vascular diseases consisting in an arteriovenous shunt at the cavernous sinus that if misdiagnosed can lead to potentially serious ophthalmologic complications. This volume provides a complete guide to the diagnosis and minimal invasive treatment of DCSFs. After sections on anatomy and classification, etiology and pathogenesis of DCSFs, the symptomatology of the disease is described in detail. The role of modern imaging techniques in the diagnosis of DCSFs is then addressed. Digital subtraction angiography (DSA) remains the gold standard for clinical decision-making; here, full consideration is given to both, conventional 2D DSA and rotational 3D angiography. Recent technological advances in this field such as Dual Volume (DV) imaging and angiographic computed tomography (ACT) are considered as well. Due attention is further paid to the use of computed tomography, magnetic resonance imaging and ultrasound. Finally, the therapeutic management of DCSFs with emphasis on various transvenous occlusion techniques are discussed in depth. This well-illustrated volume will be invaluable to all who may encounter DCSF in their clinical practice.

✦ Table of Contents

Cover......Page 1
Front-matter......Page 2
Title Page......Page 3
Copyright Page......Page 4
Dedication Page......Page 5
Foreword......Page 6
Preface......Page 7
Table of Contents......Page 9
Glossary......Page 11
1. Introduction......Page 13
2.1 Arteriovenous Fistula and Pulsating Exophthalmos......Page 15
2.2 Angiography......Page 18
2.3 Therapeutic Measures......Page 21
2.4 Embolization......Page 22
References......Page 23
3.1 Osseous Anatomy......Page 26
3.1.1 Orbit......Page 29
3.2 Anatomy of the Dura Mater and the Cranial Nerves......Page 31
3.3.1.1 Internal Carotid Artery......Page 32
Meningohypophyseal Trunk (MHT)......Page 34
The inferolateral trunk (ILT)......Page 35
Ophthalmic Artery......Page 37
Ethmoidal Arteries......Page 39
3.3.1.2.2 Internal Maxillary Artery......Page 40
3.3.1.2.4 Accessory Meningeal Artery......Page 41
3.3.2.1.2 Anatomy and Topography......Page 42
Superior Ophthalmic Vein......Page 47
Inferior Ophthalmic Vein......Page 48
Superficial Middle Cerebral Vein, Sylvian Vein......Page 49
Intercavernous Sinus, Sinus intercavernosus, Sinus circularis (Ridley), Sinus ellipticus, Sinus coronarius, Sinus clinoideus (Sir C. Bell), Sinus transversus sellae equinae (Haller)......Page 50
Inferior Petrosal Sinus, Sinus petrosus profundus, Sinus petro-occipitalis superior (Trolard)......Page 51
Marginal Sinus......Page 53
Pterygoid Plexus......Page 54
Internal Jugular Vein......Page 55
Deep Cervical Vein......Page 56
References......Page 57
4.1.1 Dural Arteriovenous Fistulas (DAVFs)......Page 62
4.1.2 Cavernous Sinus Fistulas (CSFs)......Page 65
4.3 Hemodynamic Classification......Page 71
References......Page 73
Introduction......Page 75
5.1 Etiology and Pathogenesis of Type A Fistulas......Page 76
5.2 Etiology and Pathogenesis of Type B–D Fistulas......Page 77
5.2.2 Hormonal Factors......Page 78
5.2.3 Thrombosis......Page 79
5.2.5 Trauma......Page 82
5.2.7 Congenital......Page 83
5.2.8 Other Potential Factors......Page 84
5.2.9 Various......Page 85
5.3 Prevalence......Page 86
5.3.1 Natural History......Page 88
References......Page 89
Introduction......Page 94
6.1.1 Orbital Pain......Page 95
6.2 Orbital Symptoms......Page 96
6.2.2 Conjunctival Engorgement and Chemosis......Page 97
6.2.3 Corneal Damage......Page 98
6.2.4 Orbital Bruit......Page 99
6.3 Other and Neurological Symptoms......Page 100
6.4 Differential Diagnosis......Page 101
References......Page 103
7.1.1 CT and MRI......Page 106
7.1.2 Doppler and Carotid Duplex Sonography......Page 115
7.2.2 Technique......Page 118
7.2.3 Angiographic Protocol for DCSFs......Page 119
7.2.4 Angiographic Anatomy of the Cavernous Sinus......Page 120
7.2.6 Rotational Angiography and 3D-DSA......Page 148
7.2.6.2 Angiographic Computed Tomography (ACT), DynaCT (Siemens), C-arm Flat Detector CT (FD-CT), Flat Panel CT (FP-CT) or Cone Beam CT......Page 152
7.2.6.3 Image Post-Processing......Page 155
7.2.6.4 3D Studies of the Cavernous Sinus Region......Page 157
References......Page 193
8.1 Techniques of Transvenous Catheterization......Page 198
8.1.1 Inferior Petrosal Sinus Approach......Page 200
8.1.2.2 Transcutaneous Superior Ophthalmic Vein Approach......Page 205
8.2.1 Polyvinyl Alcohol (PVA) and Embospheres......Page 206
8.2.2.1 Platinum (Non-detachable) Pushable Microcoils......Page 207
8.2.2.2 Detachable Platinum Coils......Page 208
8.2.2.3 HydroCoils......Page 211
8.2.3 Liquid Embolic Agents: Cyanoacrylates (N-butyl-cyanoacrylate, Acrylic Glue, HistoacrylTM, Tru. llTM n-BCA, GlubranTM)......Page 213
8.2.4 Onyx™ (Ethylene-Vinyl Alcohol Copolymer)......Page 214
8.2.5 Stents......Page 215
8.3.2 Angiographic and Clinical Outcome......Page 217
8.3.3.2 Case Report II: Cross-Over Approach via the IPS......Page 218
8.3.3.4 Case Report IV: Transfemoral Cross-Over Approach
via the Facial Vein and SOV......Page 224
8.3.3.6 Case Report VI: Direct Puncture of the SOV......Page 229
8.3.4 Case Illustrations......Page 234
8.4.1.1 IPS Approaches......Page 237
8.4.1.2 Thrombosed Cavernous Sinus......Page 240
8.4.1.3 Transfemoral Facial Vein/Superior Ophthalmic Vein Approach......Page 241
8.4.1.4 Approaches via the Middle Temporal Vein or the Frontal Vein......Page 242
8.4.1.7 Transfemoral Cortical Vein Approach......Page 243
8.4.1.8 Transcutaneous SOV Approach......Page 244
8.4.1.9 Transorbital SOV Approach......Page 245
8.4.1.11 Direct Puncture of the CS via the SOF......Page 246
8.4.1.12 Sylvian Vein Approach: Combined Surgical/Endovascular Treatment......Page 260
8.4.2.2 Coils......Page 261
HydroCoils (Hydrogel)......Page 264
8.4.2.3 NBCA (HistoacrylTM, GlubranTM, TrufillTM)......Page 265
8.4.2.4 Ethylene-Vinyl Alcohol Copolymer (OnyxTM)......Page 266
8.4.2.5 Stents and Covered Stents......Page 268
8.4.3 Anatomic Results, Clinical Outcome and Complications of Transvenous Occlusions and Transarterial Embolizations......Page 269
References......Page 276
9.1 Spontaneous Thrombosis......Page 285
9.2 Manual Compression Therapy......Page 288
9.3 Controlled Hypotension Case Report VIII......Page 290
9.4 Radiotherapy......Page 292
9.5 Surgery......Page 295
References......Page 297
10.1 Introduction......Page 301
10.2 Basic Hemodynamic Principles......Page 302
10.3 Invasive Assessment of Hemodynamics......Page 303
10.5 Hemodynamics and Pathophysiology in CSFs......Page 305
10.6 Flow Velocity and Pressure Measurements in DCSFs......Page 308
Comments......Page 311
References......Page 313
11 Summary......Page 316
Subject Index......Page 319

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