The Effect Of Endovascular Treatment Of Dural Arteriovenous Fistula Of Cavernous Sinus

【Background】Cavernous sinus dural arteriovenous fistula(CS-DAVF) is an abnormal arteriovenous shunt developing on the dura mater involving the cavernous sinus, which accounts for about 35% of all the DAVFs. The symptoms of CS-DAVF depend on the type of venous drainage and the flow characteristics,and may show signs of orbital hypertension including pulsatile exophthalmos and chemosis due to the adverse current of the ophthalmic venous outflow pathways, irregular movement due to the pterygoid plexus drainage, and bruit due to the inferior or superior petrosal sinus drainage,etc. The diagnosis of CS-DAVF is challenging because of its complex symptoms. Now the best method of diagnosis is digital subtraction angiography(DSA), which can show the size of fistula, location, feeding artery and draining vein of the fistula. The decision to treat CSDAVF depends mostly on the drainage pattern and the symptoms of the lesion. Some of these lesions only require conservative treatment such as the manual carotid compression. However, higher risk lesions associated with cortical venous drainage, progressive visual loss, intracranial hemorrhage and seizure are suitable for endovascular intervention, which is considered a much more effective and safer method than surgical operation with the improvement in endovascular techniques and materials. The treatment options for CSDAVFs include transarterial embolization of feeding vessels and transvenous embolization with Onyx or electrically detachable coils. Though the initial reports of transvenous embolization for CS-DAVFs have been considered to be effective, there is a lack of detailed information concerning clinical efficacy differences and the long-term follow-up results between the different managements in the literature.【 Objective 】 We conducted a retrospective analysis of patients who underwent endovascular intervention for CS-DAVF between January 2006 and January 2014 in the prospective database on vascular diseases of neurosurgery department of Tangdu Hospital. The imaging findings and medical records of 35 consecutive patients were reviewed. The symptoms and signs, approach strategies, angiographic results, complications, and clinical outcome were assessed and analyzed.【 Methods 】 We conducted a retrospective analysis of patients who underwent endovascular intervention for CS-DAVF between January 2006 and January 2014 in the prospective database on vascular diseases of neurosurgery department of Tangdu Hospital. The imaging findings and medical records of 35 consecutive patients were reviewed. The symptoms and signs, approach strategies, angiographic results, complications, and clinical outcome were assessed and analyzed.【Results】For 18 embolizations with transarterial approaches, results with Grade 1 occurred to 10 patients(55.56%), with Grade 2 to 7 patients(38.39%), with Grade 3 to 1 patient(5.56%). For 17 embolization of transvenous approach, results with Grade 1 occurred to 12 patients(70.59%), Grade 2 to 4 patients(23.52%), with Grade 3 to 1 patient(5.88%). A follow-up of 30 patients was performed by from 6 months to 3 years, of which 20 patients were totally cured, 9 patients were improved, and 1 was invalid.Clinical follow-up data were available in 30 patients. As for the effectiveness and complication incidence there was no significant statistical difference between the different approach of embolization.【Conclusion】1. Endovascular embolization with the high effective rate(96.67%) and the low complication rate(5.71%)is the first line of treatment for CS-DAVFs; 2. As for the effectiveness and complication incidence there is no significant statistical difference between transarterial embolization and transvenous embolization for CS-DAVF, and transarterial approach was better because less complexness and ratio of cost-effect.