Pindi tuli: Sparo maneris?
As much as we talk about superselective transvenous embo, one can argue that there are many ways to skin the cat. Transarterial often ain’t pretty, and also more hazardous as a rule, but it usually works. Many superselectives are simple grade 1s that one might even consider watching. The real test comes when there are no other good options — then all the training pays off…
Presentation is with progressive somnolence. The family began to notice a strange pulsating noise coming from the head, loud enough for big apple to hear.
Right ECA — MIPS
Treatment phase
On to the proximal SSS channel. Some shenanigans are needed to bounce the one tip headway duo against the balloon and enter the channel
SSS stenoses
Not much use of the SSS by the brain at this point
However… What’s happening here?
On to the next channel
Here we get into an issue
Solumbra
Making progress
Another channel
Better view now
Some more SSS plasty
Not bad so far
Now to the left
Right side is reasonable
Still got that good channel to look forward to
End of act 1. Time to go home…
Act 2 — next day
Better here also
Posterior condylar part — always nice ascending pharyngeal anatomy…
What now?
Its sledge time…
Pindi tuli: Sparo maneris?
Much better venous drainage here also
Small bit on the right
End of Act 2.
Act 3. Six months later. Right side is excellent
This was one of the more challenging transvenous sinus-sparing cases. I don’t think there is a better way today
