- •Foreword
- •Preface
- •Glossary
- •1. Introduction
- •2. Historical Considerations
- •2.1 Arteriovenous Fistula and Pulsating Exophthalmos
- •2.2 Angiography
- •2.3 Therapeutic Measures
- •2.4 Embolization
- •References
- •3.1 Osseous Anatomy
- •3.1.1 Orbit
- •3.2 Anatomy of the Dura Mater and the Cranial Nerves
- •3.2.1 Autonomic Nervous System
- •3.3 Vascular Anatomy
- •3.3.1 Arterial Anatomy
- •3.3.1.1 Internal Carotid Artery
- •Meningohypophyseal Trunk (MHT)
- •Ophthalmic Artery
- •Ethmoidal Arteries
- •3.3.1.2 External Carotid Artery
- •3.3.1.2.1 Ascending Pharyngeal Artery
- •3.3.1.2.2 Internal Maxillary Artery
- •3.3.1.2.3 Middle Meningeal Artery
- •3.3.1.2.4 Accessory Meningeal Artery
- •3.3.2 Venous Anatomy
- •3.3.2.1.1 Embryology
- •3.3.2.1.2 Anatomy and Topography
- •Orbital Veins
- •Superior Ophthalmic Vein
- •Inferior Ophthalmic Vein
- •Central Retinal Vein (No Direct CS Tributary)
- •Uncal Vein, Uncinate Vein
- •Sphenoparietal sinus (Breschet), Sinus alae parvae, Sinus sphenoidales superior (Sir C. Bell)
- •Intercavernous Sinus, Sinus intercavernosus, Sinus circularis (Ridley), Sinus ellipticus, Sinus coronarius, Sinus clinoideus (Sir C. Bell), Sinus transversus sellae equinae (Haller)
- •Meningeal Veins
- •Veins of the Foramen Rotundum, Emissary Vein
- •Inferior Petrosal Sinus, Sinus petrosus profundus, Sinus petro-occipitalis superior (Trolard)
- •Venous Plexus of the Hypoglossal Canal, Anterior Condylar Vein
- •Posterior Condylar Vein
- •Lateral Condylar Vein
- •Inferior Petroclival Vein
- •Petro-occipital Sinus, Sinus petro-occipitalis inferior, petro-occipital vein (Padget)
- •Transverse Occipital Sinus (Doyen)
- •Basilar Plexus (Virchow)
- •Marginal Sinus
- •Foramen Ovale Plexus (Trigeminal Sinus), Sphenoid Emissary, “Rete” of the Foramen Ovale
- •Vein of the Sphenoid Foramen (Foramen Venosum, Foramen of Vesalius)
- •Foramen Lacerum Plexus
- •Pterygoid Plexus
- •3.3.2.4 Other Veins of Importance for the CS Drainage or for Transvenous Access to the CS
- •Facial Vein
- •Frontal Vein
- •Angular Vein
- •Middle Temporal Vein
- •Internal Jugular Vein
- •The External Jugular Vein
- •Vertebral Vein, Vertebral Artery Venous Plexus
- •Deep Cervical Vein
- •References
- •Introduction
- •4.1.1 Dural Arteriovenous Fistulas (DAVFs)
- •4.1.2 Cavernous Sinus Fistulas (CSFs)
- •References
- •Introduction
- •5.1 Etiology and Pathogenesis of Type A Fistulas
- •5.2 Etiology and Pathogenesis of Type B–D Fistulas
- •5.2.1 Pregnancy
- •5.2.2 Hormonal Factors
- •5.2.3 Thrombosis
- •5.2.4 Venous Hypertension
- •5.2.5 Trauma
- •5.2.6 Embolization
- •5.2.7 Congenital
- •5.2.8 Other Potential Factors
- •5.2.9 Various
- •5.3 Prevalence
- •5.3.1 Natural History
- •References
- •Introduction
- •6.1 Extraorbital Ocular Symptoms
- •6.1.1 Orbital Pain
- •6.2 Orbital Symptoms
- •6.2.1 Exophthalmos
- •6.2.2 Conjunctival Engorgement and Chemosis
- •6.2.2.1 Retinal Hemorrhage
- •6.2.3 Corneal Damage
- •6.2.4 Orbital Bruit
- •6.2.6 Secondary Glaucoma and Visual Loss
- •6.3 Other and Neurological Symptoms
- •References
- •7. Radiological Diagnosis of DCSFs
- •7.1 Non-invasive Imaging Techniques
- •7.1.2 Doppler and Carotid Duplex Sonography
- •7.2 Intra-arterial Digital Subtraction Angiography (DSA)
- •7.2.1 Introduction
- •7.2.2 Technique
- •7.2.3 Angiographic Protocol for DCSFs
- •7.2.4 Angiographic Anatomy of the Cavernous Sinus
- •7.2.5 Flat Detector Technology in Neuroangiography
- •7.2.6 Rotational Angiography and 3D-DSA
- •7.2.6.1 Dual Volume Technique (DVT)
- •7.2.6.2 Angiographic Computed Tomography (ACT), DynaCT (Siemens), C-arm Flat Detector CT (FD-CT), Flat Panel CT (FP-CT) or Cone Beam CT
- •7.2.6.3 Image Post-Processing
- •7.2.6.4 3D Studies of the Cavernous Sinus Region
- •References
- •8. Endovascular Treatment
- •8.1 Techniques of Transvenous Catheterization
- •8.1.1 Inferior Petrosal Sinus Approach
- •8.1.2 Alternative Approaches to the Cavernous Sinus
- •8.1.3 Other Techniques
- •8.2 Embolic Agents
- •8.2.1 Polyvinyl Alcohol (PVA) and Embospheres
- •8.2.2 Stainless Steel Coils
- •8.2.5 Stents
- •8.3.1 Approaches (Benndorf et al. 2004)
- •8.3.2 Angiographic and Clinical Outcome
- •8.4 Discussion of Transvenous Occlusions
- •8.4.1 Approaches
- •8.4.1.1 IPS Approaches
- •8.4.1.6 Transfemoral Pterygoid Plexus Approach (PP Approach)
- •8.4.1.7 Transfemoral Cortical Vein Approach
- •8.4.1.10 Direct Puncture of the Foramen Ovale
- •8.4.2 Embolic Materials
- •8.4.2.1 Particles
- •8.4.2.2 Coils
- •HydroCoils (Hydrogel)
- •8.4.2.4 Ethylene-Vinyl Alcohol Copolymer (OnyxTM)
- •8.4.2.5 Stents and Covered Stents
- •8.4.3 Anatomic Results, Clinical Outcome and Complications of Transvenous Occlusions and Transarterial Embolizations
- •8.5 Conclusion
- •References
- •9. Alternative Treatment Options
- •9.1 Spontaneous Thrombosis
- •9.2 Manual Compression Therapy
- •9.4 Radiotherapy
- •9.5 Surgery
- •References
- •10. Hemodynamic Aspects of DCSFs
- •10.1 Introduction
- •10.2 Basic Hemodynamic Principles
- •10.3 Invasive Assessment of Hemodynamics
- •10.4 Flow Velocity and Pressure Measurements in Brain AVMs and DAVFs
- •10.5 Hemodynamics and Pathophysiology in CSFs
- •Comments
- •References
- •11. Summary
- •Subject Index
5.3 Prevalence |
79 |
Table 5.3. Frequency of cortical/leptomeningeal venous drainage and associated hemorrhage
Authors |
DCSFs C/LVD |
Hemorrhage |
|||
Halbach et al. 1987 |
30 |
3 |
(10%) |
|
|
Awad et al. 1990 a |
45 |
n/a |
n/a |
||
Cognard et al. 1995 |
33 |
4 |
(12%) |
0 |
|
Tomsick 1997 |
50 |
8 |
(16%) |
0 |
|
Satomi et al. 2005 b |
65 |
17 (26.1%) |
1 |
(1.5%) |
|
Theaudin et al. 2006 |
27 |
5 |
(18.5%) |
0 |
|
Stiebel-Kalish |
88 |
22 |
(26%) |
2 |
(2.2%) |
et al. 2002 |
|
|
|
|
|
Meyers et al. 2002 |
135 |
41 (31%) |
2 |
(1.5%) |
|
a 17 cases and metaanalysis |
b Cases of benign DAVF |
||||
In summary, lacking accurate data, only limited knowledge on prevalence and natural history in patients harboring DCSFs exist. Larger studies with long-term follow-up of patients, not undergoing any sort of treatment including manual compression therapy, will be needed to obtain reliable information on the natural course of the disease. The term “benign” fistula, referring to a generally milder clinical course, does not appear suitable and should be reserved for diseases of that biological nature.
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