Neurointervention.  2011 Feb;6(1):6-12. 10.5469/neuroint.2011.6.1.6.

Treatment Strategy Based on Multimodal Management Outcome of Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF)

• Choi BS
• Park JW
• Kim JL
• Kim SY
• Park YS
• Kwon HJ
• Lee DH
• Suh DC

• KMID: 1783975
• DOI: http://doi.org/10.5469/neuroint.2011.6.1.6

Abstract

PURPOSE
Angiographic finding including venous drainage pattern should be correlated to the presenting symptom pattern (SxP) in CSDAVF. We present outcome of CSDAVF management and suggest a strategy according to SxP and type of treatment based on our experience.
MATERIALS AND METHODS
We evaluated SxP, angiographic type (proliferative, restrictive or late restrictive), mode of treatment (embolization, Gamma Knife Radiation (GKR) or conservative management), mode of embolization (transarterial or transvenous), and final clinical status (cure, improvement, aggravation or no change). Ninety consecutive patients were included from a prospective database. The mean follow-up was 17 months. We compared the outcomes according to SxP, angiographic type, mode of treatment, and embolization using the chi-square or Fisher's exact test.
RESULTS
Ninety patients with 34 proliferative, 40 restrictive, and 16 late restrictive types of CSDAVF were treated by embolization (n = 63), GKR (n = 7), and conservative management (n = 20). Cure or improvement was 91% after embolization, 88% after conservative management, and 72% after GKR. Following embolization, 100% of 24 proliferative types, 87% of 30 restrictive types, and 90% of 10 late restrictive types were cured or improved. Cure or improvement after transvenous embolization was 98% (43/44) compared with 88% (15/17) after transarterial embolization (p = 0.003).
CONCLUSION
Various factors of SxP, angiographic type, and mode of treatment should be considered in order to obtain a more favorable outcome for patients with CSDAVF. Embolization via venous approach tended to result in a more complete cure than that via arterial approach.

Keyword

Cavernous sinus; Dural arteriovenous fistula; Endovascular treatment; Transvenous embolization

MeSH Terms

Cavernous Sinus
Caves
Central Nervous System Vascular Malformations
Drainage
Follow-Up Studies
Humans
Prospective Studies

Figure

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  Fig. 1 A 68-year-old female presented with chemosis, exophthalmos, diplopia, and ocular pain on both sides. Her occluar pressure was 33/33 mmHg (right/left). (A) Left internal carotid arterigram shows a dural arteriovenous fistula in the cavernous sinus. Microcatheter angiogram showed that both dilated cavernous sinuses were filled on the anterioposterior view (B) after a venous approach through the right inferior petrosal sinus into the left cavernous sinus as well as into the fistular pouch as seen on the lateral view (C). (D) The final left internal carotid arteriogram revealed that complete devascularization was achieved after coil embolization of the fistular pouch. On the two-month follow-up, the patient's symptoms and signs had completely disappeared and her ocular pressure had returned to normal (15/14 mmHg).

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