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We decided to treat via the pterygoid plexus. A jugular venous approach to the lesion was chosen, and an <t>Echelon-10/Transend</t> EX Soft Tip was delivered through the pterygoid plexus and CS to the fistula and into the aneurysm. Slab MIP images ( A–C ), sagittal sections, of 3D rotational angiography during the procedure show that the Echelon ( black arrows ) passes through the drainage route through the foramen ovale ( white arrowhead ) and reaches the aneurysm. In the anteroposterior ( D ) and lateral ( E ) views of the fluoroscopy, a Headway-17 45°/Transend EX Soft Tip was inserted using the sheeping technique to the vicinity of the foramen ovale immediately before the fistula. Black and white arrows indicate the tips of the Echelon-10 and Headway-17 microcatheter, respectively.
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transend-14 microguidewire  (Stryker)
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We decided to treat via the pterygoid plexus. A jugular venous approach to the lesion was chosen, and an <t>Echelon-10/Transend</t> EX Soft Tip was delivered through the pterygoid plexus and CS to the fistula and into the aneurysm. Slab MIP images ( A–C ), sagittal sections, of 3D rotational angiography during the procedure show that the Echelon ( black arrows ) passes through the drainage route through the foramen ovale ( white arrowhead ) and reaches the aneurysm. In the anteroposterior ( D ) and lateral ( E ) views of the fluoroscopy, a Headway-17 45°/Transend EX Soft Tip was inserted using the sheeping technique to the vicinity of the foramen ovale immediately before the fistula. Black and white arrows indicate the tips of the Echelon-10 and Headway-17 microcatheter, respectively.
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We decided to treat via the pterygoid plexus. A jugular venous approach to the lesion was chosen, and an Echelon-10/Transend EX Soft Tip was delivered through the pterygoid plexus and CS to the fistula and into the aneurysm. Slab MIP images ( A–C ), sagittal sections, of 3D rotational angiography during the procedure show that the Echelon ( black arrows ) passes through the drainage route through the foramen ovale ( white arrowhead ) and reaches the aneurysm. In the anteroposterior ( D ) and lateral ( E ) views of the fluoroscopy, a Headway-17 45°/Transend EX Soft Tip was inserted using the sheeping technique to the vicinity of the foramen ovale immediately before the fistula. Black and white arrows indicate the tips of the Echelon-10 and Headway-17 microcatheter, respectively.

Journal: Journal of Neurosurgery: Case Lessons

Article Title: Transvenous embolization of the direct carotid-cavernous fistula via the pterygoid plexus: illustrative case

doi: 10.3171/CASE22558

Figure Lengend Snippet: We decided to treat via the pterygoid plexus. A jugular venous approach to the lesion was chosen, and an Echelon-10/Transend EX Soft Tip was delivered through the pterygoid plexus and CS to the fistula and into the aneurysm. Slab MIP images ( A–C ), sagittal sections, of 3D rotational angiography during the procedure show that the Echelon ( black arrows ) passes through the drainage route through the foramen ovale ( white arrowhead ) and reaches the aneurysm. In the anteroposterior ( D ) and lateral ( E ) views of the fluoroscopy, a Headway-17 45°/Transend EX Soft Tip was inserted using the sheeping technique to the vicinity of the foramen ovale immediately before the fistula. Black and white arrows indicate the tips of the Echelon-10 and Headway-17 microcatheter, respectively.

Article Snippet: An Echelon-10 microcatheter (Medtronic) was delivered through the pterygoid plexus and the CS to the fistula and into the aneurysm, which was navigated by a Transend EX Soft Tip microguidewire (Stryker).

Techniques: