Direct Carotid-Cavernous Fistula Tranvenous Onyx Embolization

And a beautiful example of laterocavernous sinus — a separate compartment lateral to the cavernous sinus proper, draining Superficial sylvian veins independently from the cavernous sinus congested by fistula

This what latero-cavernous sinus looks like on PPT. Both Laterocavernous and Paracavernous sinus are essentially variations of Superficial Sylvian Venous drainage.

Direct post-traumatic CC fistula

ECA to prove its not dural

Frontal view, double contrast — arterial phase is mask image.  Venous phase shows separate drainage of superficial sylvian veins into the laterocavernous sinus (black arrow)

Lateral closeup.  Hole in is the posterior genu

Transarterial access failed.  Therefore we go transvernous, from right IJ to right inferior petrosal sinus to intercavernous sinus, to posterior left cavernous sinus.  A balloon is inflated in the left ICA across fistula to cavernous sinus flow so as to allow Onyx to set in the right places and to protect the carotid


Post. Arterial phase shows no more fistula.  Venous phase shows preserved superficial sylvian venous drainage via laterocavernous sinus (black arrow frontal) and of head via foramina ovale and spinosum (black arrow lateral)

Global views

Lateral common carotid view artrial mask showing MMA in foramen spinosum (arrow)

For other examples of laterocavernous sinus see Cavernous Sinus Page