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Endoscopic endonasal transsphenoidal Onyx embolization of a paracavernous dural arteriovenous fistula
  1. Patrick J Karas1,
  2. Jae Eun Lee2,
  3. Brian T Oliver1,
  4. Randall Z Allison1,
  5. Katherine A Lees3,
  6. Hashem Shaltoni4,
  7. Peter Kan1
  1. 1 Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  2. 2 Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  3. 3 Otolaryngology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  4. 4 Neurology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  1. Correspondence to Dr Peter Kan, Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA; ptkan{at}utmb.edu

Abstract

Paracavernous dural arteriovenous fistulas (pdAVFs) are extremely rare and can mimic carotid cavernous fistulas (CCFs) in both clinical presentation and imaging characteristics. Access to the venous pouch often presents the greatest challenge in the treatment of pdAVFs. Here we present a novel access technique utilizing an endoscopic endonasal transsphenoidal approach, where we directly puncture the venous pouch under both stereotactic guidance and endoscopic visualization, thereby completely embolizing a pdAVF with no alternate access (video 1).

Video 1 Technical video demonstrates the complete embolization of a pdAVF using an endoscopic endonasal transsphenoidal approach.
  • Liquid Embolic Material
  • Fistula
  • Technique

https://doi.org/10.1136/jnis-2022-019971

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    Footnotes

    • Twitter @PeterKa80460001

    • Contributors Conception and design: PK, PJK. Interpretation and analysis of manuscript: PK, PJK. Writing, editing, and approval of technical videos: all authors. Study supervision: PK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer PK: leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid: Journal of NeuroInterventional Surgery Editorial Board.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.