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http://dx.doi.org/10.3348/kjr.2018.19.2.334

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)
Publication Information
Korean Journal of Radiology / v.19, no.2, 2018 , pp. 334-341 More about this Journal
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
Cavernous sinus; Dural fistula; Arteriovenous fistula; Embolization; Bilateral; Transvenous embolization; Endovascular treatment;
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1 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   DOI
2 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   DOI
3 Newton TH, Cronqvist S. Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 1969;93:1071-1078   DOI
4 van Dijk JM, TerBrugge KG, Willinsky RA, Wallace MC. Multiplicity of dural arteriovenous fistulas. J Neurosurg 2002;96:76-78   DOI
5 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
6 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   DOI
7 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   DOI
8 Diez Lobato R, Escudero L, Lamas E. Bilateral dural arteriovenous fistula in the region of the cavernous sinus. Neuroradiology 1978;15:39-43   DOI
9 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   DOI
10 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   DOI
11 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   DOI
12 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   DOI
13 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   DOI
14 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   DOI
15 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   DOI
16 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   DOI
17 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   DOI
18 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
19 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
20 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   DOI
21 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   DOI
22 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   DOI
23 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   DOI
24 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   DOI
25 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   DOI
26 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   DOI
27 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   DOI
28 Kikuchi K, Kowada M. Anterior fossa dural arteriovenous malformation supplied by bilateral ethmoidal arteries. Surg Neurol 1994;41:56-64   DOI
29 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   DOI