Endovascular Treatment of Bilateral Cavernous Sinus Dural Arteriovenous Fistula: Therapeutic Strategy and Follow-Up Outcomes.
10.3348/kjr.2018.19.2.334
- Author:
Jong Kook RHIM
1
;
Young Dae CHO
;
Dong Hyun YOO
;
Hyun Seung KANG
;
Won Sang CHO
;
Jeong Eun KIM
;
Min Jae CHO
;
Gyojun HWANG
;
O Ki KWON
;
Moon Hee HAN
Author Information
1. Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63241, Korea.
- Publication Type:Original Article
- Keywords:
Cavernous sinus;
Dural fistula;
Arteriovenous fistula;
Embolization;
Bilateral;
Transvenous embolization;
Endovascular treatment
- MeSH:
Arteriovenous Fistula;
Asian Continental Ancestry Group;
Cavernous Sinus*;
Central Nervous System Vascular Malformations*;
Cranial Nerve Diseases;
Endovascular Procedures;
Fistula;
Follow-Up Studies*;
Humans
- From:Korean Journal of Radiology
2018;19(2):334-341
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization. MATERIALS AND METHODS: Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment. RESULTS: At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits. CONCLUSION: With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.
