Bilateral Cavernous Sinus Dural Arteriovenous Fistulae

Fay, Li Yu; Luo, Chao-Bao; Chen, Liang Wei; Wu, Jau Ching; Wu, Chieh Hsin; Chang, Feng Chi; Lin, Chung Jung

doi:10.1007/s00062-019-00868-z

Cited by 2 publications

(8 citation statements)

References 28 publications

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“…This retrospective single-center study provides detailed dosimetry data for the endovascular treatment of intracranial LDAVF in 70 patients between 2014 and 2019. In particular, we believe that the strict selection criteria (e.g., exclusion of other intracranial fistulae, such as carotid-cavernous fistula [ 17 ] or anterior cranial fossa DAVF [ 18 ]) as well as the dedicated consideration of both the Cognard grade and endovascular technique (TA liquid embolization with EVOH and/or TV coil embolization) is unique and may therefore be valuable in order to introduce novel DRLs in the field of interventional neuroradiology considering the paramount impact of the Euratom Basic Safety Standards directive [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

et al. 2020

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Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.

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Section: Discussionmentioning

confidence: 99%

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

et al. 2020

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“…The endovascular procedures were performed via unilateral inferior petrosal sinus (IPS) catheterization in 48 (53%) patients, bilateral IPS catheterization in 29 (32%) patients, an approach with the side of IPS not specified in three (3%) patients, and the superior ophthalmic vein (SOV) approach in 10 (11%) patients. Unilateral IPS and bilateral IPS occlusion rates were reported in three studies, with a pooled incidence of 22% (95% CI 6–57%, I 2 = 80%) and 15% (95% CI 7–28%, I 2 = 31%), respectively 2 , 3 , 17 . Embolization agents were mainly coils in 58 (62%) patients and coils combined with N-butyl cyanoacrylate (nBCA) or onyx in 30 (32%) patients.…”

Section: Resultsmentioning

confidence: 97%

“…Seventy relevant articles were retrieved for a full-length article review, and 10 studies were excluded because they did not specify the results of the bilateral CSDAVF, and 52 studies owing to less case numbers (Supplemental Tables 3 and 4 ). The remaining eight articles were included in the review (Table 1 ) 2 , 3 , 13 – 18 . The process is summarized in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Cavernous sinus dural arteriovenous fistula (CSDAVF) is the abnormal connection between arteries and veins within the cavernous sinus 1 . Most CSDAVF occurs unilaterally; however, bilateral CSDAVF have also been observed in some patients, including 14.2–26% of patients who suffer from CSDAVF 2 , 3 . The definition of bilateral CSDAVF is that the fistulas at each cavernous sinus have individual feeding arteries and venous drainage that can be visualized using highly selective digital subtraction angiography (DSA) 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Unlike the comprehensive understanding of unilateral CSDAVF 10 , 11 , the clinical picture and related outcomes of endovascular treatment of bilateral CSDAVF are still under investigation. A greater hemodynamic impact is observed owing to more feeders and drainage veins 12 , and more complicated anatomies with difficult treatment strategies separate bilateral CSDAVF from unilateral CSDAVF 3 . Owing to the aforementioned reasons, we performed a systematic review of pertinent studies with the aim of illustrating the current classification, clinical symptoms and signs, approach techniques, clinical-angiographic outcomes, and complication rate of bilateral CSDAVF treated in an endovascular fashion.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular treatment in bilateral cavernous sinus dural arteriovenous fistulas: a systematic review and meta-analysis

Perng

Chang

Sun

et al. 2023

Sci Rep

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Few studies have discussed the disease nature and treatment outcomes for bilateral cavernous sinus dural arteriovenous fistula (CSDAVF). This study aimed to investigate the clinical features and treatment outcomes of bilateral CSDAVF. Embase, Medline, and Cochrane library were searched for studies that specified the outcomes of bilateral CSDAVF from inception to April 2022. The classification, clinical presentation, angiographic feature, surgical approach, and treatment outcomes were collected. Meta-analysis was performed using the random effects model. Eight studies reporting 97 patients were included. The clinical presentation was mainly orbital (n = 80), cavernous (n = 52) and cerebral (n = 5) symptoms. The most approached surgical route was inferior petrosal sinus (n = 80), followed by superior orbital vein (n = 10), and alternative approach (n = 7). Clinical symptoms of 88% of the patients (95% CI 80–93%, I2 = 0%) were cured, and 82% (95% CI 70–90%, I2 = 7%) had angiographic complete obliteration of fistulas during follow up. The overall complication rate was 18% (95% CI 11–27%, I2 = 0%). Therefore, endovascular treatment is an effective treatment for bilateral CSDAVF regarding clinical or angiographic outcomes. However, detailed evaluation of preoperative images and comprehensive surgical planning of the approach route are mandatory owing to complexity of the lesions.

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Bilateral Cavernous Sinus Dural Arteriovenous Fistulae

Cited by 2 publications

References 28 publications

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

Endovascular treatment in bilateral cavernous sinus dural arteriovenous fistulas: a systematic review and meta-analysis

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