Direct Puncture of the Cavernous Sinus as Alternative Approach to Treat a Dural Arteriovenous Fistula of the Hypoglossal Canal

Excerpt

Dural arteriovenous fistulas (DAVF) of the hypoglossal canal (HC) represent a rare subtype of fistula involving the anterior condylar confluence (ACC) and/or the anterior condylar vein (ACV) [2, 3, 5, 7]. The location around the ACC predisposes HCDAVFs to complex venous connections with the orbit, the posterior fossa dural sinuses, and the external and internal vertebral venous system [3, 6, 7]. When the anterograde drainage of the HCDAVF to the ipsilateral internal jugular vein (IJV) is absent or restricted, that drainage may be redirected to the cavernous sinus and orbital veins via the inferior petrosal sinus (IPS) [2, 6, 7]. In such situations, a transvenous approach to the ACC through the cavernous sinus is the treatment of choice. Although the venous approach is successful in most cases, transvenous access may be unavailable to reach the fistulous zone via the cavernous sinus [1]. This article presents an alternative approach to treat HCDAVF by direct transorbital puncture of the cavernous sinus. This percutaneous approach has been described to treat DAVFs of the cavernous sinus but it has never been reported to treat anterior condylar fistulas [8]. …