Cavernous region dural fistulas with venous drainage of laterocavernous sinus

Background : We present our findings concerning the laterocavernous sinus (LCS) drainage of cavernous region dural fistulas, focusing our attention on the anatomy of LCS as it may have important implications in the treatment.
Patients and Methods : Thirty-one consecutive patients with cavernous region dural fistulas treated endovascularly between 2005 and 2008 were reviewed. Five patients had angiographic features such as cavernous region dural fistulas draining with superficial middle cerebral vein (SMCV) via LCS. Clinical records of these 5 patients were focused upon to determine their presenting symptoms, angiographic features, endovascular treatments and clinical outcomes.
Results : Among 31 cases of cavernous dural arteriovenous fistula (DAVF), 5 (16%) cases with leptomeningeal veins [SMCV, petrosal vein] reflux via LCS were noted. The 5 cavernous region dural fistulas were defined as Cognard type III and Barrow type A (1/5), B (1/5), C (1/5) and D (2/5). All 5 patients underwent immediate obliteration of the cavernous region dural fistulas in 3 sessions of transarterial and 2 sessions of transvenous embolization. An angiographic obliteration and clinical cure was achieved in all patients. We encountered one minor complication of local hair loss induced by X-ray radiation. A complete resolution of the initial presenting symptoms was observed within a few days to weeks. Six-month follow-up angiogram in 5 patients showed obliteration and no recanalization of CCF.
Conclusion : It is very important to diagnose the presence of laterocavernous sinus in dural arteriovenous fistulas during diagnostic angiography. It is believed that the knowledge of the existence of laterocavernous sinus might be relevant for the understanding and treatment of dural fistulas involving the cavernous sinus and its lateral wall.