Difficulties in Transvenous Embolization via the Cavernous Sinus: Buddy-Wire Anchoring Technique

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• The cavernous sinus (CS) drains venous blood from the temporal lobe via the superficial middle cerebral vein (SMCV).
• Brain arteriovenous malformations (AVMs) on temporal and parietal lobes often drain into the SMCV.
• Catheter entrapment in the CS can complicate transvenous embolization of SMCV-draining AVMs.

Purpose of the Study:

• To describe a novel bailout technique for microcatheter entrapment in the CS during transvenous embolization of brain AVMs.
• To introduce the buddy-wire anchoring technique for navigating the CS and accessing the SMCV.

Main Methods:

• A video article demonstrating a bailout technique for microcatheter entrapment.
• Utilizing an additional microguidewire as an anchor to support microcatheter advancement.
• Application of the buddy-wire anchoring technique during transvenous embolization procedures.

Main Results:

• The buddy-wire anchoring technique successfully prevented microcatheter entrapment in the CS.
• This technique facilitated distal catheterization of the SMCV.
• Demonstrated the feasibility of the technique in the context of brain AVM treatment.

Conclusions:

• The buddy-wire anchoring technique is an effective bailout strategy for CS microcatheter entrapment.
• This technique enables safe and successful transvenous embolization of brain AVMs with SMCV drainage.
• This is the first report of the buddy-wire anchoring technique for brain AVM embolization.