Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review

Nishimuta, Yosuke; Awa, Ryuji; Sugata, Sei; Nagayama, Tetsuya; Makiuchi, Tsuneo; Tomosugi, Tetsuzo; Hanaya, Ryosuke; Tokimura, Hiroshi; Hirano, Hirofumi; Moinuddin, F M; Kamil, Muhammad; Kibe, Akari; Arita, Kazunori

doi:10.1007/s00701-017-3336-4

Cited by 18 publications

(27 citation statements)

References 39 publications

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“…And patient # 19 finally was treated by a transarterial partial embolization of the fistula network using onyx over branches of the left ECA, whereas the neuromeningeal branch of the ascending pharyngeal artery was omitted due to the high risk of cranial nerve palsy.The vast majority of the patients (26/30, 87%) report good subjective satisfaction with the long-term treatment result, hence we state, that the patients themselves perceive their treatment to be highly beneficial to them. In addition to good rates of angiographic and clinical cure described in former publications [8,9], this is another important argument in favor of an endovascular treatment even if the indication constellation is only a relative one.…”

Section: Plos Onementioning

confidence: 87%

“…Endovascular techniques as a treatment option for idCCF have emerged over the past years and there are some publications on the complication and success rates of this method [8][9][10]. But whereas indication to treat is indisputable in fistulas associated with cortical venous drainage (CVD), neurologic deficits, intradural hemorrhage, venous thrombosis, or altered mental status [8] any other clinical presentation of an idCCF only offers a relative treatment indication.…”

Section: Introductionmentioning

confidence: 99%

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Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

et al. 2020

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PurposePatient-reported long-term follow-up after endovascular treatment of indirect carotid cavernous fistulas is important, but rarely addressed in literature. We report on this issue with a special focus on the patient's view and its impact on the indication evaluation process. MethodsWe retrospectively reviewed the records of all patients (n = 33) with a minimum follow-up interval of at least 36 and up to 166 months after endovascular treatment of an indirect carotid cavernous fistula (Barrow B-D) at our institution (treated from 01/2003 to 06/2015). We determined treatment details including primary therapy success and complication rate and quote the patient's subjective perception of the long-term treatment success using a standardized interview form. ResultsAs a primary result the fistula was completely occluded in 25/33 cases (76%), while a downgrading was achieved in 8/33 (24%) of the cases. Secondary occlusion was observed in three out of eight patients (38%). In the long-term interview (response rate: 91%, median follow-up interval: 114 months) 87% of the patients reported high satisfaction with the longterm therapy result. Endovascular treatment achieved a sustainable relief from all eyerelated symptoms in 89% and from pulsatile tinnitus in 57% of the cases.

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Section: Plos Onementioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

et al. 2020

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“…Its safety and effectiveness have already been reported, and long-term acceptable outcomes have also been achieved. 3,5,6,8,14) Furthermore, selective TVE of the shunted pouch has been performed to avoid inadequate packing or overpacking of the sinus. 9) As a TVE route for the treatment of CS-dAVF, the ipsilateral IPS is usually used to advance the microcatheter into the affected CS because of its accessibility.…”

Section: Discussionmentioning

confidence: 99%

“…Transvenous embolization (TVE) is generally accepted as the first choice for endovascular intervention to treat CS-dAVF. [1][2][3][4][5][6][7][8] Furthermore, with the development of DSA, detailed diagnosis of the shunted pouch has become possible; selective TVE has also become possible in recent years. 9) In TVE for CS-dAVF, the inferior petrosal sinus (IPS) is usually selected as the initial access route to the affected CS because of its accessibility.…”

Section: Introductionmentioning

confidence: 99%

“…To date, TVE has been reported using several venous routes rather than the IPS. 1,3,5,6,8,[10][11][12] However, we sometimes encounter cases where the affected CS cannot be reached from these alternative routes at the time of actual treatment. Sinus or vein organized thrombosis and hypoplasia or aplasia may affect microcatheter advancement.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Therapeutic Access Routes for Endovascular Therapy of Cavernous Sinus-dural Arteriovenous Fistula

Ryu

Sato

Mochizuki

et al. 2019

JNET

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The usefulness of endovascular treatment for cavernous sinus (CS)-dural arteriovenous fistula (dAVF) has been established. As the first choice of endovascular intervention for CS-dAVF, transvenous embolization (TVE) is generally performed, and the inferior petrosal sinus (IPS) is usually selected as the main access route to the affected CS because of its accessibility. However, the angiographical pattern of the CS varies among individuals. In some cases, it is difficult to access the affected CS via the ipsilateral IPS because of thrombosis, hypoplasia, or aplasia. Therefore, in some cases, alternative venous access routes are needed for TVE. Methods: A retrospective study was performed with 27 patients diagnosed with intracranial dAVF who underwent endovascular embolization at our institution. Among these, the data of nine patients with CS-dAVF treated by endovascular intervention were analyzed retrospectively in this study. We reviewed the endovascular access routes for CS-dAVF treatment based on anatomical and embryological considerations. Results: The most common complaint was diplopia, followed by exophthalmos and chemosis. There was no hemorrhagic onset. Cortical venous reflux (CVR) was recognized angiographically in six patients. The IPS on the affected side was angiographically occluded in four patients. TVE was attempted first in all patients. In five patients where the ipsilateral IPS was patent, TVE was successfully performed via the ipsilateral IPS. In four patients where the ipsilateral IPS was occluded, microcatheter access to the affected CS via the ipsilateral IPS was unsuccessful. The following alternative approach routes were selected: the superficial temporal vein, facial vein, direct puncture of the superficial middle cerebral vein (SMCV), and ascending pharyngeal artery (APA) for transarterial intravenous embolization (TAIV). The CS-dAVF had disappeared in all patients at the final follow-up examination. In the case of difficult access, compartment formations of the intracavernous sinus were recognized. Compartment formation due to the anatomical and embryological differences of the intracavernous structure may have influenced the ability of the catheter to reach the affected shunted pouch. Conclusions: In cases where the approach via the ipsilateral IPS was difficult, alternative access routes were effective for the required embolization. It is extremely important to fully understand the angioarchitecture, location of the shunted pouch, and compartments of the CS for successful endovascular treatment. Anatomical and developmental CS considerations may be useful for better access route selection. Keywords▶ ascending pharyngeal artery, cavernous sinus, dural arteriovenous fistula, transarterial embolization, transvenous embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

et al. 2021

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Purpose Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.

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Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review

Abstract: Long-term follow-up showed that EVT, especially tVE, is an efficient and safe treatment for CS-dAVF. It resulted in the eventual disappearance of shunt flow. Residual shunt without major retrograde flow or cortical venous reflux can be monitored without additional treatment.

Cited by 18 publications

References 39 publications

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

Assessment of Therapeutic Access Routes for Endovascular Therapy of Cavernous Sinus-dural Arteriovenous Fistula

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

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