Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Endovascular Treatment of Bilateral Cavernous Sinus Dural Arteriovenous Fistula: Therapeutic Strategy and Follow-Up Outcomes

  • Rhim, Jong Kook (Department of Neurosurgery, Jeju National University College of Medicine) ;
  • Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yoo, Dong Hyun (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Cho, Won-Sang (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Cho, Min Jae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hwang, Gyojun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kwon, O-Ki (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2017.03.26
  • Accepted : 2017.08.20
  • Published : 2018.04.01
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Abstract

Objective: Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization. Materials and Methods: Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment. Results: At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits. Conclusion: With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.

Keywords

References

  1. Cawley CM, Barrow DL, Dion JE. Treatment of lateral-sigmoid and sagittal sinus dural arteriovenous malformations. In: Winn HR, Youmans JR, eds. Youmans neurological surgery Volume 2, 5th ed. Philadelphia, PA: WB Saunders, 2004:2283-2291
  2. Collice M, D’Aliberti G, Talamonti G, Branca V, Boccardi E, Scialfa G, et al. Surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulas without dural sinus drainage. J Neurosurg 1996;84:810-817 https://doi.org/10.3171/jns.1996.84.5.0810
  3. Hwang H, La YK, Baek MS, Baik K, Suh SH, Kim WJ. Dural arteriovenous fistula manifested as rapid progressive dementia successfully treated by endovascular embolization only. Neurointervention 2017;12:50-53 https://doi.org/10.5469/neuroint.2017.12.1.50
  4. Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB, Wilson CB. A variant of arteriovenous fistulas within the wall of dural sinuses. Results of combined surgical and endovascular therapy. J Neurosurg 1991;74:199-204 https://doi.org/10.3171/jns.1991.74.2.0199
  5. Kikuchi K, Kowada M. Anterior fossa dural arteriovenous malformation supplied by bilateral ethmoidal arteries. Surg Neurol 1994;41:56-64 https://doi.org/10.1016/0090-3019(94)90209-7
  6. Cho YD, Rhim JK, Yoo DH, Kang HS, Kim JE, Cho WS, et al. Transvenous microguidewire looping technique for breach of ipsilateral inferior petrosal sinus occlusions en route to cavernous sinus dural arteriovenous fistulas. Interv Neuroradiol 2016;22:590-595 https://doi.org/10.1177/1591019916653251
  7. Rhim JK, Cho YD, Park JJ, Jeon JP, Kang HS, Kim JE, et al. Endovascular treatment of cavernous sinus dural arteriovenous fistula with ipsilateral inferior petrosal sinus occlusion: a single-center experience. Neurosurgery 2015;77:192-199; discussion 199 https://doi.org/10.1227/NEU.0000000000000751
  8. Suh DC, Lee JH, Kim SJ, Chung SJ, Choi CG, Kim HJ, et al. New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns. Stroke 2005;36:1134-1139 https://doi.org/10.1161/01.STR.0000166194.82027.63
  9. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671-680 https://doi.org/10.1148/radiology.194.3.7862961
  10. Newton TH, Cronqvist S. Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 1969;93:1071-1078 https://doi.org/10.1148/93.5.1071
  11. van Dijk JM, TerBrugge KG, Willinsky RA, Wallace MC. Multiplicity of dural arteriovenous fistulas. J Neurosurg 2002;96:76-78 https://doi.org/10.3171/jns.2002.96.1.0076
  12. Dabus G, Batjer HH, Hurley MC, Nimmagadda A, Russell EJ. Endovascular treatment of a bilateral dural carotid-cavernous fistula using an unusual unilateral approach through the basilar plexus. World Neurosurg 2012;77:201.e5-e8
  13. Chaloupka JC, Goller D, Goldberg RA, Duckwiler GR, Martin NA, Vinuela F. True anatomical compartmentalization of the cavernous sinus in a patient with bilateral cavernous dural arteriovenous fistulae. Case report. J Neurosurg 1993;79:592-595 https://doi.org/10.3171/jns.1993.79.4.0592
  14. Courtheoux P, Labbe D, Hamel C, Lecoq PJ, Jahara M, Theron J. Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy. Case report. J Neurosurg 1987;66:468-470 https://doi.org/10.3171/jns.1987.66.3.0468
  15. Diez Lobato R, Escudero L, Lamas E. Bilateral dural arteriovenous fistula in the region of the cavernous sinus. Neuroradiology 1978;15:39-43 https://doi.org/10.1007/BF00327444
  16. Hacein-Bey L, Konstas AA, Pile-Spellman J. Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas. Clin Neurol Neurosurg 2014;121:64-75 https://doi.org/10.1016/j.clineuro.2014.01.018
  17. Chung SJ, Kim JS, Kim JC, Lee SK, Kwon SU, Lee MC, et al. Intracranial dural arteriovenous fistulas: analysis of 60 patients. Cerebrovasc Dis 2002;13:79-88 https://doi.org/10.1159/000047755
  18. Kojima T, Miyachi S, Sahara Y, Nakai K, Okamoto T, Hattori K, et al. The relationship between venous hypertension and expression of vascular endothelial growth factor: hemodynamic and immunohistochemical examinations in a rat venous hypertension model. Surg Neurol 2007;68:277-284; discussion 284 https://doi.org/10.1016/j.surneu.2006.10.075
  19. Ha SY, Kwon YS, Kim BM, Kim DI, Kim DJ. Clinical and angiographic characteristics of multiple dural arteriovenous shunts. AJNR Am J Neuroradiol 2012;33:1691-1695 https://doi.org/10.3174/ajnr.A3054
  20. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985;62:248-256 https://doi.org/10.3171/jns.1985.62.2.0248
  21. Vinuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 1984;60:976-984 https://doi.org/10.3171/jns.1984.60.5.0976
  22. Benndorf G, Bender A, Lehmann R, Lanksch W. Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature. Surg Neurol 2000;54:42-54 https://doi.org/10.1016/S0090-3019(00)00260-3
  23. Jung KH, Kwon BJ, Chu K, Noh Y, Lee ST, Cho YD, et al. Clinical and angiographic factors related to the prognosis of cavernous sinus dural arteriovenous fistula. Neuroradiology 2011;53:983-992 https://doi.org/10.1007/s00234-010-0805-3
  24. Kim DJ, Kim DI, Suh SH, Kim J, Lee SK, Kim EY, et al. Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management. AJNR Am J Neuroradiol 2006;27:2078-2082
  25. Lewis AI, Tomsick TA, Tew JM Jr. Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery 1995;36:239-244; discussion 244-245 https://doi.org/10.1227/00006123-199502000-00001
  26. Debrun G, Lacour P, Vinuela F, Fox A, Drake CG, Caron JP. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 1981;55:678-692 https://doi.org/10.3171/jns.1981.55.5.0678
  27. Sergott RC, Grossman RI, Savino PJ, Bosley TM, Schatz NJ. The syndrome of paradoxical worsening of dural-cavernous sinus arteriovenous malformations. Ophthalmology 1987;94:205-212 https://doi.org/10.1016/S0161-6420(87)33472-4
  28. Nagy ZZ, Nemeth J, Suveges I, Lanyi F. A case of paradoxical worsening of dural-sinus arteriovenous malformation syndrome after neurosurgery. Eur J Ophthalmol 1995;5:265-270 https://doi.org/10.1177/112067219500500412
  29. Nishino K, Ito Y, Hasegawa H, Kikuchi B, Shimbo J, Kitazawa K, et al. Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils. J Neurosurg 2008;109:208-214 https://doi.org/10.3171/JNS/2008/109/8/0208

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