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

About this book

Dural cavernous sinus fistulas (DCSFs) represent a benign vascular disease, consisting in an arteriovenous shunt at the cavernous sinus. In the absence of spontaneous resolution, the fistula may lead to eye redness, swelling, proptosis, chemosis, ophthalmoplegia and visual loss. Although modern imaging techniques have improved the diagnostic, patients with low-flow DCSFs are still misdiagnosed. These patients can get erroneously treated for infections and inflammation for months or years and are at risk of visual loss. Early and proper diagnosis helps to avoid deleterious clinical course of the disease. This volume provides a complete guide to clinical and radiological diagnosis as well as to therapeutic management of DCSF with emphasis on modern minimal invasive treatment options. It commences with an informative description of relevant anatomy. After sections on the classification, etiology and pathogenesis of DCSF, the clinical symptomatology of the disease is described in detail. The role of modern non-invasive imaging tools is then addressed with the use of computed tomography, magnetic resonance imaging and ultrasound. Intra-arterial digital subtraction angiography (DSA), although invasive, remains the gold standard and is mandatory for clinical decision-making and strategy in endovascular treatment. Hence, a throughout consideration is given to both, 2D-DSA and 3D rotational angiography, including recent technological advancements such as Dual Volume (DV) imaging and angiographic computed tomography (ACT). After a short section on arteriovenous hemodynamics, the therapeutic management of DCSFs is described in detail. In particular, various transvenous techniques, required for successful endovascular occlusion of DCSF, are discussed in depth. This well-illustrated volume will be invaluable to all who may encounter DCSF in their clinical practice.

Written for:

Clinicians and practitioners in the fields of Neuroradiology, Radiology, Interventional Neuroradiology, Interventional Radiology, Neurology, Neurosurgery, and Ophthalmology

Keywords:

• cavernous sinus
• dural arteriovenous fistula
• embolization
• endovascular therapy
• transvenous occlusion

Table of contents

Introduction.- Anatomy of the Cavernous Sinus: Osseous Anatomy.- Dura Mater.-Vascular Anatomy.- Cranial Nerves.- Classification of Cavernous Sinus Fistulas (CSF) and Dural Arteriovenous Fistulas (DAVF). - Etiology and Pathogenesis of Dural Cavernous Sinus Fistulas (DCSF).- Neuroophthalmology: Extraorbital Ocular Symptoms.- Orbital Pain.- Orbital Symptoms.- Other Neurological Symptoms.- Radiological diagnosis of DSCF: Imaging Techniques (CT, MRI, US).- Conventional Intraarterial Angiography (CA).- Hemodynamic Considerations: General Hemodynamic Aspects.- Hemodynamics in DCSF.- Treatment of DSCF: Conservative Treatment.- Manual Compression.-Spontaneous Thrombosis.- Surgical Treatment and Radiotherapy.- Endovascular Treatment.- Subject Index.