Transvenous embolization through the ipsilateral deep facial vein: A novel approach route for treatment of a cavernous sinus dural arteriovenous fistula

The superior ophthalmic vein (SOV) approach through the facial vein is usually preferred for transvenous embolization of a cavernous sinus dural arteriovenous fistula (CS DAVF) when the ipsilateral inferior petrosal sinus is angiographically occluded. However, navigating the microcatheter can sometimes be difficult because of stenosis or tortuous angulation at the junction between the angular vein and SOV. We present a novel transvenous access route to treat a CS DAVF using the ipsilateral deep facial vein through the SOV to reach the cavernous sinus. A 66-year-old woman presented with left-sided chemosis, exophthalmos, and external ophthalmoplegia. Angiography showed a left CS DAVF associated with a dilated SOV and retrograde cortical venous reflux. A dilated drainage vein, which branched from the SOV, ran through the lateral aspect of the orbit and exited the orbit through the inferior orbital fissure. This vein connected with the ipsilateral deep facial vein draining into the facial and internal jugular veins. We performed transvenous embolization via the SOV approach through the deep facial vein and achieved complete obliteration, by placing 3 platinum coils, without complications. Ophthalmic veins may connect with the cavernous sinus and pterygoid plexus, passing through the superior and inferior orbital fissures, respectively. Our case suggests that the deep facial vein may provide access to the SOV through the inferior orbital fissure without passing the difficult tortuous angle between the angular vein and SOV

Loss of CO2-induced Distensibility in Cerebral Arteries with Chronic Hypertension or Vasospasm after Subarachnoid Hemorrhage

We developed a rat cerebral angiography system using monochromatic synchrotronradiation X-rays at SPring-8, a third generation synchrotron radiation facility. Usingnew technique, we assessed the distensibility of major trunk arteries after subarachnoidhemorrhage (SAH) in normotensive and hypertensive rats. Twenty-five adult WistarKyoto rats (WKY) and fourteen stroke-prone spontaneously hypertensive rats (SHR)were prepared SAH by double hemorrhage injection method into cisterna magna.Angiography was performed on day 7 and was repeated three times in each rat beforeand after loading of hypercapnia at 100-120 mmHg of PaCO2. The diameters of majortrunk vessels were assessed. Light microscopic observation of artery lumen and wallwere also performed. Angiographical vasospasm was demonstrated in basilar artery inWKY with 66 % reduction in diameter of control. In ICA and other major trunk inWKY and all the arteries in SHR did not demonstrate vasospasm. SHA resulted in lossof hypercapnia-induced distention in BA of WKY. In SHR, the distensibility wasimpaired regardless of hemorrhage. Histological study demonstrated basilar artery inWKY thickened at 184 % after SAH and became similar to non-hemorrhagic SHR.ICA in WKY and both BA and ICA in SHR were unchanged in wall thickness beforeand after SAH. High quality angiography demonstrated deteriorated distensibility inchronic hypertension or SAH-induced spastic vessels