J Korean Radiol Soc.  1999 May;40(5):835-844. 10.3348/jkrs.1999.40.5.835.

Emboilzation of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

• Oh YT
• Kim DI
• Yoon PH
• Lee GC
• Hur SG
• Jeon P
• HWang GJ
• Lim JS

• KMID: 2200983
• DOI: http://doi.org/10.3348/jkrs.1999.40.5.835

Abstract

PURPOSE: To compare the results of endovascular treatment by using transarterial, transvenous, or a combinedapproach in cavernous dural arteriovenous fistulars(CDAVF).
MATERIALS AND METHODS
Twenty-nine angiographicallyconfirmed CDAVF patients underwent endovascular treatment. Initial presenting symptoms and the characteristics ofCDAVF, as seen on angiograms, were investigated. Patients were divided according to Barrow 's classification.Using embolic materials, endovascular treatment was performed transarterially or transvenously, and the clinicalresults were retrospectively evaluated during follow up ranging from 5 to 122(mean 48.8) months.
RESULTS
Allpatients complained of ocular symptoms. Twenty six (90%) showed congestive symptoms related to superior ophthalmicvein drainage, but three presented with only opthalmoplegia without congestion. According to Barrow 'sclassification, patients were classified as follows : type B(n=2), type C(n=1), or type D(n=26). Twenty-fourpatients had a unilateral CDAVF, and five a bilateral CDAVF. The results of angiographic treatment were as follows: completely treated in 8 cases(28%), partially treated in 21(72%). Clinical symptoms completely disappeared in 19patients, for eight of these treatment was entirely angiographic, while for 11 it was partially angiographic.Clinical improvements were noted in eight patients, but in two, visual acuity progressively decreased. In 12patients who underwent transarterial treatment, the clinical results were as follows : complete cure in five(42%),improvement in five(42%), and progressively decreasing visual acuity in two(16%). Among 17 patients who underwenttransvenous or transvenous with transarterial treatment, complete cure was seen in 14(82%), and improvement inthree(18%).
CONCLUSION
Twenty-seven of 29 CDAVF patients were completely cured or improved after endovasculartreatment. For type-D patients, transvenous with transarterial treatment led to a higher cure rate than thetransarterial approach alone.

Keyword

Fistula, arteriovenous; Arteries, therapeutic blockade

MeSH Terms

Arteriovenous Fistula
Cavernous Sinus*
Central Nervous System Vascular Malformations*
Drainage
Estrogens, Conjugated (USP)
Follow-Up Studies
Humans
Retrospective Studies
Visual Acuity
Estrogens, Conjugated (USP)