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

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