case_images: PMC9904405_01
case_images: (A) MRI revealed mild dilation of bilateral superior ophthalmic veins (white arrows). Angiography of the right external carotid artery (B-E), right vertebral artery (F) and the left common carotid artery (G) showed the right HCDAVF, which was drained into the cavernous sinus through IPS vein, then entered the facial vein through the right ophthalmic vein, and finally reached the external jugular vein. HCDAVF, Dural arteriovenous fistulas of the hypoglossal canal. The patient's right internal jugular vein is not occluded (H) and the left IPS was occluded (I). IPS, inferior petrosal sinus.
case_images: fsurg-09-1043340-g001.jpg
case_images: PMC9904405_01_fsurg-09-1043340-g001.jpg
case_images: F1
case_images: This patient had a bilateral inferior petrosal sinus occlusion with no good inferior petrosal sinus access (Figure 1).
case_images: (A) The echelon-10 microcatheter (black arrow) was superselected for the right ascending pharyngeal artery. (B) The tip of the Marathon microcatheter (white arrow) was positioned at the right ACC. (C) The frontal view showed the position of the microcatheters. Onyx-18 was injected through the Echelon-10 microcatheter (D) and then injected into the venous bag through the Marathon microcatheter (E) and the shape of the venous bag (F) was obtained. The post-embolization angiography of the right innominate artery (G, H), left CCA (I) and late venous phase (J) showed complete obliteration of the fistula. ACC, anterior condylar confluence; IPS, inferior petrosal sinus.
case_images: fsurg-09-1043340-g002.jpg
case_images: PMC9904405_01_fsurg-09-1043340-g002.jpg
case_images: F2
case_images: Under the roadmaps, the superselective Echelon-10 microcatheter (Medtronic, Inc., USA) was routed through the 5F guide wire (Johnson, USA) to the right ascending pharyngeal artery (Figure 2A). The Marathon microcatheter (Medtronic, Inc., USA) over Synchro-10 microline (Stryker, USA) was advanced to the right IPS via the right external jugular vein, facial vein, ophthalmic vein, and cavernous sinus, and was superselected to the right anterior condylar confluence (Figures 2B,C). Onyx-18 (Medtronic, Inc., USA) was injected through the microcatheter to reduce the arterial inflow (Figure 2D). Onyx-18 was then slowly injected into the venous pouch through the Marathon microcatheter to obtain the shape of the venous pouch. The injection was stopped immediately when the reflux of Onyx-18 to the IPS was observed, and approximately 3 ml Onyx-18 was used (Figures 2E,F). The post-embolization angiography demonstrated complete obliteration of the fistula (Figures 2G-J).