Korean J Cerebrovasc Surg.  2011 Sep;13(3):215-221.

Cranial Nerve Palsy in Patients with Cavernous Sinus Dural Arteriovenous Fistula Treated with Embolization: A Single Institution Retrospective Analysis

Affiliations
  • 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Neurosurgery, Seoul National University Hospital, Korea.
  • 3Department of Neurosurgery, Seoul National University Bundang Hospital, Korea. kwonoki@snu.ac.kr

Abstract

OBJECTIVE: Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arteriovenous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment.
METHODS
Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation, the neurological deficits, the radiographic features and the treatment outcomes.
RESULTS
In our series, a total of 25 patients (28 cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by previous treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up.
CONCLUSION
Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.

Keyword

Cavernous sinus; Dural arteriovenous fistula; Endovascular treatment; Cranial nerve palsy
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