Drainage outflow restriction as a parameter associated with cortical venous reflux in craniofacial arteriovenous malformations with cavernous sinus drainage
Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to demonstrate how it affected our treatment strategy.
Cases of CF-AVMs associated with CS drainage were collected from a prospectively collected database of patients with CF-AVMs who underwent endovascular treatment from September 2016 to March 2018. Clinical data and angioarchitectural findings were analyzed. Factors associated with the presence of venous reflux (cortical venous reflux (CVR) or dural sinus reflux (DSR)) were analyzed.
Fifteen CF-AVM patients associated with CS drainage were analyzed. Three cases of venous reflux from the CS were identified (CVR, 2; DSR, 1). Lesions with unilateral venous drainage, ≤ 2 draining veins, and the absence of antegrade CS outflow were more likely to develop venous reflux from the CS. We successfully performed additional trans-venous coil embolization of the superior ophthalmic vein in two patients with malformations associated with venous reflux to close this venous connection to the CS.
CF-AVMs associated with CS drainage confer an increased risk of CVR and DSR, especially in cases where the drainage outflow is restricted. Identification of this venous angioarchitecture is essential in the evaluation and treatment planning of CF-AVMs.
KeywordsArteriovenous malformations Craniofacial Cavernous sinus Embolization Venous reflux
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
- 1.Rhoton AL Jr (2002) The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery 51:S375–S410Google Scholar
- 8.Servo A (1982) Visualization of the superior ophthalmic vein on carotid angiography. Neuroradiology 23:141–146Google Scholar
- 10.Suzuki Y, Matsumoto K (2000) Variations of the superficial middle cerebral vein: classification using three-dimensional CT angiography. AJNR Am J Neuroradiol 21:932–938Google Scholar
- 11.Song JK, Patel AB, Duckwiler GR, Gobin YP, Jahan R, Martin NA, Cacayorin ED, Viñuela F (2002) Adult pial arteriovenous fistula and superior sagittal sinus stenosis: angiographic evidence for high-flow venopathy at an atypical location. Case report. J Neurosurg 96:792–795. https://doi.org/10.3171/jns.2002.96.4.0792. CrossRefGoogle Scholar
- 12.Ramirez-Amador V, Esquivel-Pedraza L, Lozada-Nur F, De la Rosa-Garcia E, Volkow-Fernandez P, Suchil-Bernal L et al (2002) Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi’s sarcoma. A double blind, randomized clinical trial. Oral Oncol 38:460–467CrossRefGoogle Scholar