Endovascular Approaches to the Carotid Cavernous Sinus for Endovascular Treatment of Carotid Cavernous Fistulas and Hormone Sampling

A precise knowledge of the venous morphology of the carotid cavernous sinus is essential in order to choose the appropriate access routes to the cavernous sinus. The sinus is trabeculated and subdivided in compartments. Newton and Potts 1 mentioned two parts, the anterior and posterior part. The anterior receives blood from the superior ophthalmic vein (SOV), inferior ophthalmic vein (IOV), sphenoparietal sinus and superficial middle cerebral vein (sylvian vein). We prospectively investigated the morphology of the cavernous sinus in recent ten consecutive dural carotid cavernous fistula (CCF) patients treated using three dimensional (3D) coils. All CCFs of our series except two were mainly under the internal carotid artery. According to our findings, we divided all cavernous sinuses into three compartments: the antero-lateral; intermediate; and postero-medial (Fig 1). The anterolateral compartment combined with the postero-medial compartment make up the anterior part of Newton and Potts 1. The antero-lateral compartment receives blood as mentioned above and sometimes from the olfactory vein and deep middle cerebral veins. The intermediate compartment receives blood from the pterigoid plexus. The postero-medial compartment corresponds to the posterior part of Newton and Potts 1. The postero-medial compartment mainly receives blood from the inferior petrosal sinus (IPS). The two cavernous sinuses communicate with each other by way of coronary (anterior and posterior intercavernous) sinuses anteriorly and occipital transverse sinus posteriorly.