{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:51:38Z","timestamp":1781862698098,"version":"3.54.5"},"reference-count":17,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n In cavernous sinus dural arteriovenous fistulas (CS-dAVFs), posterior venous drainage may become occluded first, followed by anterior drainage, occasionally leading to spontaneous resolution. Immediately before this stage, however, a phenomenon known as paradoxical worsening may occur, in which symptoms rapidly deteriorate despite apparent angiographic improvement because of progressive venous outflow obstruction. In such cases, the shunt pouch (SP) becomes nearly isolated, and the lesion must be reached by penetrating the occluded cavernous sinus (CS) along a conventional access route, which is not always technically straightforward. We report a case in which a chronic total occlusion (CTO) wire enabled access to the lesion and definitive cure.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n An 83-year-old woman presented to a local ophthalmologist with left conjunctival injection. Ophthalmological examination revealed full and smooth ocular movements without any obvious abnormality. Intraocular pressure was within the normal range, and no abnormal findings were noted in the visual fields or visual acuity. Brain magnetic resonance imaging demonstrated a left CS-dAVF. The lesion was fed by the middle meningeal artery and the meningohypophyseal trunk of the internal carotid artery and drained from the left CS into the left superior ophthalmic vein. Transvenous embolization (TVE) was selected, and access was obtained through the right internal jugular vein. We entered the normal right CS via the right inferior petrosal sinus and then attempted to advance into the contralateral isolated sinus; however, passage was difficult with a conventional wire. By using a CTO wire (Vassallo 40), we were able to reach the isolated SP, and the microcatheter was subsequently advanced to the shunt point, allowing curative TVE.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n We experienced a favorable case of an isolated CS shunt in which access from the normal CS was difficult, but the lesion was reached with a CTO wire and successfully treated by TVE. In cases with difficult venous access, a CTO wire may represent a useful adjunct.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_289_2026","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:58:16Z","timestamp":1781859496000},"page":"356","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A case of cavernous sinus dural arteriovenous fistula successfully treated using a chronic total occlusion wire"],"prefix":"10.25259","volume":"17","author":[{"given":"Akihiro","family":"Shimoi","sequence":"first","affiliation":[{"name":"Neurovascular Center, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroo","family":"Yamaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Terada","sequence":"additional","affiliation":[{"name":"Neurovascular Center, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"10.25259\/SNI_289_2026\/ref-1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S0090-3019(00)00260-3","article-title":"Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: Report of four cases and review of the literature","volume":"54","author":"Benndorf","year":"2000","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_289_2026\/ref-2","first-page":"1240","article-title":"Cavernous sinus dural fistulae treated by transvenous approach through the facial vein: Report of seven cases and review of the literature","volume":"24","author":"Biondi","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_289_2026\/ref-3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.wneu.2020.05.013","article-title":"Surgical sparing and pairing endovascular interventions for carotid-cavernous fistula: Case series and review of the literature","volume":"140","author":"Brenna","year":"2020","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_289_2026\/ref-4","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1097\/00006123-199711000-00017","article-title":"Direct microsurgery of dural arteriovenous malformation type carotid-cavernous sinus fistulas: Indications, technique, and results","volume":"41","author":"Day","year":"1997","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_289_2026\/ref-5","doi-asserted-by":"crossref","first-page":"68896","DOI":"10.3340\/jkns.2021.0250","article-title":"Use of a rigid-tipped microguidewire for the endovascular treatment of cavernous sinus dural arteriovenous fistulas with an occluded inferior petrosal sinus","volume":"65","author":"Deniwar","year":"2022","journal-title":"J Korean Neurosurg Soc"},{"key":"10.25259\/SNI_289_2026\/ref-6","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.wneu.2013.02.033","article-title":"The evolution of endovascular treatment of carotid cavernous fistulas: A single-center experience","volume":"80","author":"Ducruet","year":"2013","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_289_2026\/ref-7","doi-asserted-by":"crossref","first-page":"e7374","DOI":"10.1097\/MD.0000000000007374","article-title":"Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis: A case report and review of literature","volume":"96","author":"Fu","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"10.25259\/SNI_289_2026\/ref-8","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/WNO.0b013e3181989fc0","article-title":"Endovascular techniques for treatment of carotid-cavernous fistula","volume":"29","author":"Gemmete","year":"2009","journal-title":"J Neuroophthalmol"},{"key":"10.25259\/SNI_289_2026\/ref-9","doi-asserted-by":"crossref","first-page":"974","DOI":"10.3171\/jns.2006.104.6.974","article-title":"Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula. Technical note","volume":"104","author":"Hanaoka","year":"2006","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_289_2026\/ref-10","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5797\/jnet.5.68","article-title":"Microcatheter pull-up technique using gooseneck snare in transvenous embolization for cavernous sinus dural arteriovenous fistula: Technical note","volume":"5","author":"Hasegawa","year":"2011","journal-title":"J Neuroendovasc Ther"},{"key":"10.25259\/SNI_289_2026\/ref-11","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.7150\/ijms.45210","article-title":"Endovascular treatment of the cavernous sinus dural arteriovenous fistula: Current status and considerations","volume":"17","author":"Hou","year":"2020","journal-title":"Int J Med Sci"},{"key":"10.25259\/SNI_289_2026\/ref-12","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s00701-002-0997-3","article-title":"Transfemoral, transvenous embolisation of dural arteriovenous fistula involving the isolated transverse-sigmoid sinus from the contralateral side","volume":"144","author":"Komiyama","year":"2002","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_289_2026\/ref-13","first-page":"1329","article-title":"Surgical transvenous embolization of a cortically draining carotid cavernous fistula via a vein of the sylvian fissure","volume":"19","author":"Kuwayama","year":"1998","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_289_2026\/ref-14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1177\/159101991101700209","article-title":"Mechanism of the formation of dural arteriovenous fistula-the role of the emissary vein","volume":"17","author":"Miyachi","year":"2011","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_289_2026\/ref-15","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1007\/s002340100550","article-title":"Percutaneous transvenous embolisation through the occluded sinus for transverse-sigmoid dural arteriovenous fistulas with sinus occlusion","volume":"43","author":"Naito","year":"2001","journal-title":"Neuroradiology"},{"key":"10.25259\/SNI_289_2026\/ref-16","doi-asserted-by":"crossref","first-page":"634","DOI":"10.25259\/SNI_1035_2021","article-title":"Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein","volume":"12","author":"Shibata","year":"2021","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_289_2026\/ref-17","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00701-007-1264-4","article-title":"Transvenous embolization for dural transverse sinus fistulas with occluded sigmoid sinus","volume":"149","author":"Wong","year":"2007","journal-title":"Acta Neurochir (Wien)"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/a-case-of-cavernous-sinus-dural-arteriovenous-fistula-successfully-treated-using-a-chronic-total-occlusion-wire\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/a-case-of-cavernous-sinus-dural-arteriovenous-fistula-successfully-treated-using-a-chronic-total-occlusion-wire\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:58:18Z","timestamp":1781859498000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/a-case-of-cavernous-sinus-dural-arteriovenous-fistula-successfully-treated-using-a-chronic-total-occlusion-wire\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":17,"alternative-id":["10.25259\/SNI_289_2026"],"URL":"https:\/\/doi.org\/10.25259\/sni_289_2026","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"article-number":"356"}}