Embolization of cavernous sinus dural arteriovenous fistula via inferior petrosal sinus: anatomical basis and management practicability.

The aim of this study is to explore anatomical basis and reevaluate the practicability of embolization of cavernous sinus dural arteriovenous fistulas (CSdAVFs) via the inferior petrosal sinus (IPS) with detachable coils and Onyx-18. In this study, retrospective studies were performed on 15 consecutive patients with CSdAVFs via the IPS treated by Onyx-18 and detachable coils in Qilu hospital between March 2009 and January 2013. One patient was treated with Onyx-18 only and others were treated by Onyx-18 combined with coils. The median follow-up time was 30 months, ranged from 16 to 54 months. The results indicated that all patients experienced clinical relief. The patient treated with Onyx-18 only acquired incomplete embolization and then carotid compression was continued for 1 week. The other 14 patients treated by Onyx-18 combined with coils got the complete embolization. Complications were encountered in 8 patients, including reflex bradycardia (40%, n=6), cranial nerve III palsy aggravation (6.6%, n=1) and postoperative headache (6.6%, n=1). No patients had recurrent symptoms during the follow-up period. In conclusion, combined with coils, Onyx-18 can enter the "culprit chambers" of the CS and occlude the fistula. Embolization via the opacified or nonopacified IPS was practicable and safe enough. The approach also can improve cure rates and reduce medical expenses.