Embolization treatment of dural arteriovenous fistula in the cavernous sinus region via facial vein approach

Objective To investigate the method and efficacy of dural arteriovenous fistula (AVF) in the cavernous sinus region treated via facial vein approach. Methods The facial vein approach was performed by retrograde catheterization of the internal jugular vein-facial vein-angular vein-superior ophthalmic vein-cavernous sinus.The clinical data of 7 patients with AVF in the cavernous sinus region treated via facial vein approach were analyzed retrospectively. Among them, 5 patients experienced sinus occlusion, and 1 experienced the inferior petrosal sinus (IPS) patency, but there was no communication between the cavernous sinus and IPS in the AVF. The fistula of 1 patient connected with IPS. The posterior cavernous sinus were occluded first via IPS, and then the anterior cavernous sinus were occluded via facial vein approach. The other 6 patients were occluded via facial vein only. Results Angiography showed that in 7 patients the course and distribution of the angular vein and SOV were clear. In one patients with SOV occlusion, the transvenous procedure was stopped because of the catheter could not be inserted into the occluded SOV. After the fistulas were occluded with coils via facial vein approach in the remaining 6 patients, 4 were completely occluded, and 2 improved significantly. Conclusion Compared with other intravenous approaches, the endovascular treatment of the dural AVF in cavernous sinus region via femoral vein to facial vein approach is a valuable approach. Even if this approach requires higher operative skills, but it is a safe and effective method for endovascular treatment.