Transvenous Treatment of Carotid Cavernous and Dural Arteriovenous Fistulae: Results for 31 Patients and Review of the Literature

Author:

Klisch Joachim1,Huppertz Hans Juergen2,Spetzger Uwe2,Hetzel Andreas3,Seeger Wolfgang2,Schumacher Martin1

Affiliation:

1. Department of Neuroradiology, University of Freiburg, Freiburg, Germany

2. Department of Neurosurgery, University of Freiburg, Freiburg, Germany

3. Department of Neurology, University of Freiburg, Freiburg, Germany

Abstract

Abstract OBJECTIVE To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches. METHODS Retrospective analysis of data for 31 patients (age range, 17–81 yr; mean age, 59.3 yr) with carotid cavernous fistulae (n = 6) or dural AVFs (cavernous sinus [CS], n = 11; transverse/sigmoid sinus, n = 14) was performed. The AVFs were treated with coils via different transvenous approaches, in 56 procedures. Doppler ultrasonography and time-resolved, two-dimensional, magnetic resonance projection angiography were performed to confirm the treatment. The mean clinical follow-up period was 32.5 months. RESULTS A total of 34 transvenous procedures were performed for 17 AVFs of the CS. Eleven patients with AVFs of the CS (63%) were cured with respect to clinical symptoms, and six patients experienced improvement (37%). The approach via the internal jugular vein and inferior petrosal sinus (n = 15) was possible in 60% of cases, with complete occlusion of the fistula in 78% of cases. With the approach via the facial vein (n = 8), there was a 50% success rate. The superior ophthalmic vein approach (n = 5) was associated with a high rate of technical success (100%), with a rate of complete fistula occlusion of 80%. We encountered complications, with transient morbidity, in four cases (23.5%). For 14 dural AVFs of the transverse/sigmoid sinus, 22 transvenous procedures were performed; 12 patients were cured (85.7%) and 2 experienced improvement (14.3%). The technical success rate was 86%, with complete occlusion in 42% of cases. Minor complications occurred in six cases (42.9%) but did not lead to permanent morbidity. CONCLUSION Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference117 articles.

1. Deterioration of ocular motor dysfunction after transvenous embolization of dural arteriovenous fistulas involving the cavernous sinus;Aihara;Acta Neurochir (Wien),1999

2. Treatment of carotid-cavernous fistulas by embolization of the cavernous sinus through venous affluents or direct puncture;Albert;Acta Neurochir Suppl (Wien),1988

3. Standards of practice: Arteriovenous fistulae of the central nervous system;American Society of Interventional and Therapeutic Neuroradiology;AJNR Am J Neuroradiol,2001

4. Intracranial dural arteriovenous malformations: Factors predisposing to an aggressive neurological course;Awad;J Neurosurg,1990

5. Transethmoidal transsphenoidal approach for embolization of a carotid-cavernous fistula: Case report;Barker;J Neurosurg,1994

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