Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

Hassan, Tamer; Rashad, Sherif; Aziz, Waseem; Sultan, Ahmed; Ibrahim, Tamer

doi:10.1016/j.jstrokecerebrovasdis.2015.08.016

Cited by 22 publications

(12 citation statements)

References 49 publications

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“…In Alexander et al's (2019) study with 267 patients, the complication rate was 3.6%, and permanent symptomatic complications only occurred in 0.51% of the patients [16]. Compared with TVE, TAE has a higher complication rate [16,86]. In TVE, coil embolization has fewer complications than liquid embolic agents [16,87].…”

Section: Complicationsmentioning

confidence: 99%

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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A cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication involving the dura mater within or near the CS wall. The dural arteries from the internal carotid artery and external carotid artery supply the CS-DAVF, and the superior ophthalmic vein (SOV) and inferior petrous sinus (IPS) are frequent venous drainers. In CS-DAVF cases, high-risk lesions require treatment. Endovascular treatment (EVT) has been the first-line option for CS-DAVFs. To our knowledge, a review of the EVT of CS-DAVFs is lacking. Therefore, in this paper, we review the available literature on this issue. In addition, some illustrative cases are also provided to more concisely expound the EVT of CS-DAVFs. According to the recent literature, transvenous embolization via the IPS is considered the most effective method for EVT of CS-DAVFs. In addition, the transorbital approach is another reasonable choice. Other venous approaches can also be tried. Because of the low cure rate, transarterial embolization for CS-DAVFs is limited to only highly selected patients. In the EVT of CS-DAVFs, various agents have been used, including coil, Onyx, and n-butyl cyanoacrylate, with coil being the preferred one. In addition, when EVT cannot obliterate the CS-DAVF, stereotactic radiotherapy may be considered. In general, despite various complications, EVT is a feasible and effective method to manage CS-DAVFs by way of various access routes and can yield a good prognosis.

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Section: Complicationsmentioning

confidence: 99%

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Hou¹,

Li²,

Luan³

et al. 2020

Int. J. Med. Sci.

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“…Known complications after Onyx embolisation of CCFs include cranial nerve neuropathies, embolic internal carotid artery events and transient haemodynamic instability 6 7. In our patient, we suspect that CCF embolisation caused thrombosis of small adjacent arterial fistula branches, resulting in devascularisation of the posterior pituitary gland.…”

Section: Discussionmentioning

confidence: 69%

Republished: Development of syndrome of inappropriate antidiuretic hormone secretion (SIADH) after Onyx embolisation of a cavernous carotid fistula

Chen

Kalani

Ducruet

et al. 2016

J NeuroIntervent Surg

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Patients with cavernous carotid fistulas (CCFs) can present with pituitary hypoperfusion and hypopituitarism; however, there are no previous reports of pituitary or hormonal abnormalities developing after CCF embolisation in an asymptomatic patient. We describe a patient with no hormonal abnormalities who developed syndrome of inappropriate antidiuretic hormone (SIADH) secretion after CCF embolisation. The patient had bilateral indirect CCFs, which were completely embolised via a transvenous approach, and was neurologically stable postoperatively and discharged. In the subsequent 2 weeks the patient was readmitted twice for acute hyponatraemia and a tonic-clonic seizure. Laboratory studies revealed severe SIADH. Clinical status and sodium levels improved after treatment. One year later the patient was weaned off all medications and remained neurologically stable. SIADH may be a delayed phenomenon after CCF embolisation. Given the proximity of embolised vessels to the pituitary's vascular supply, CCF treatment may result in flow disturbance, ischaemia and hormonal abnormalities.

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“…This is done by balloon occlusion test and demonstrating good cross-flow through the circle of Willis. 2 16 In chronic cases, the ICA becomes significantly tortuous in course. In many of these high-flow fistulas, most of the flowing ICA blood passes into the venous system through the fistulous communication producing steal phenomenon and relative hypoperfusion of distal circulation.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Direct Carotid–Cavernous Fistula: Evolution of Cost Effective Sandwich Technique

Prasad

Singh

Boruah

et al. 2020

JNRP

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Objective There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid–cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloons were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.78%). Parent arterial occlusion was performed in 10 patients (22.22%). There was complete resolution of chemosis and bruit in all the patients. Conclusions Endovascular treatment is the mainstay of management in direct CCF. Using more fibered thrombogenic coils in a sandwich manner decreases the cost of the treatment significantly.

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Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

Cited by 22 publications

References 49 publications

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Endovascular treatment of the cavernous sinus dural arteriovenous fistula: current status and considerations

Republished: Development of syndrome of inappropriate antidiuretic hormone secretion (SIADH) after Onyx embolisation of a cavernous carotid fistula

Endovascular Management of Direct Carotid–Cavernous Fistula: Evolution of Cost Effective Sandwich Technique

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