Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils

Abstract

The cumulative volume and specific locations of coils in the CS correlated with TVE-induced CNP. Overpacking appeared to be the predominant cause of CNP; however, for CNP in cases involving smaller coil volumes, an alternative mechanism may be involved.

Endovascular targeted coil embolization using dual vessel approach for traumatic direct carotid cavernous fistula following severe head trauma: technical notes

“…(7) These permanent symptoms were associated with the space-occupying effect of the coil density in CS, and a coil volume of >200 mm3 was reported to be a critical factor. (7,8) Furthermore, dense packing of large areas of the CS includes not only the element of high cost for the amount of coils used but also difficulties in determining the optimal volume of coils. Therefore, as an alternative to dense CS packing, targeted coil embolization aimed at treating only the affected area is a reasonable strategy to reduce the number of coils used; in addition, morbidity rates are decreased by decreasing coil volume.…”

Long-Term Outcome after Coil Embolization of Cavernous Sinus Arteriovenous Fistulas: Fig 1.

“…In a recent study on CNP as a peri-interventional complication occurring in 39.4% of patients either as aggravation or new CNP, a coil volume Ͼ200 mm 3 was reported to be critical. 2 Alternative to dense packing of the whole sinus, some authors have described targeted embolization, especially in dural AVF of the cavernous sinus aimed at the involved compartment after careful delineation of the precise fistulous point. [28][29][30] This could be an alternative with a lower chance of persistent CNP.…”

“…1 Before intervention, fistulas were classified on the basis of their arterial supply and venous drainage patterns. 1 The compartments of the cavernous sinus affected by the fistula as well as the compartments with dense coil packing were determined in relationship to cranial nerve compartmental anatomy according to the scheme of Nishino et al 2 These evaluations were performed retrospectively, via consensus, by 2 experienced neuroradiologists blinded to the clinical symptoms.…”

“…Trochlear nerve function was not assessed in patients with oculomotor deficits because it is difficult to evaluate trochlear dysfunction when other cranial nerve palsies are present. 2 The clinical outcome for each parameter was stratified into cured (when the symptom no longer existed), improved (when the intensity had decreased), unchanged, or worsened (when symptoms had worsened or new symptoms had developed).…”

“…[1][2][3][4][5][6][7][8][9][10] Periprocedural aggravation or new CNP as well as preinterventional neuro-ophthalmic problems are reported to have a good prognosis. 2 Most previous studies gave an overall rating of the clinical outcome in patients following endovascular treatment of the AVF of the cavernous sinus without reporting the detailed neuro-ophthalmologic findings. In the early follow-up of patients with cavernous sinus AVF, we had the impression that incomplete regression of CNP is more common than has been reported in the literature.…”