Transvenous Onyx embolization of cavernous sinus dural arteriovenous fistula using a balloon catheter in the arterial side for flow control

Abstract

Background Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts involving the dura mater, located within or near the walls of the CS. Transvenous embolization is considered to be an effective treatment for CS DAVF. We describe a novel technique for the use of transvenous Onyx embolization in the treatment of CS DAVF, which uses a temporary balloon to occlude the arterial side for flow control. Case Report A 63-year-old woman presented with ocular pain and ptosis of the left eye. Cerebral angiography showed a left CS DAVF fed by multiple branches of the left external carotid artery. We successfully treated the CS DAVF using transvenous Onyx embolization with temporary balloon occlusion of the proximal feeding artery to decrease the shunted flow. Conclusion Transvenous Onyx embolization with flow control via temporary balloon occlusion may be a useful technique for the embolization of CS DAVFs with multiple arterial feeders.

Keywords

• cavernous sinus
• arteriovenous fistula
• endovascular technique
• balloon occlusion