Efficiency of endovascular therapy for bilateral cavernous sinus dural arteriovenous fistula

Efficiency of endovascular therapy for bilateral cavernous sinus dural arteriovenous fistula:



Publication date: Available online 10 October 2020

Source: World Neurosurgery

Author(s): Anchalee Churojana, Ittichai Sakarunchai, Thaweesak Aurboonyawat, Ekawut Chankaew, Pattarawit Withayasuk, Boonrerk Sangpetngam



Abstract

Background

The principles of endovascular treatment of bilateral cavernous sinus dural arteriovenous fistula (CS-dAVF) are not well established due to the complexity in the number of fistula tracts and their behavior which seems to be more aggressive. We aimed to determine an efficient technique for endovascular treatment of bilateral CS-dAVF and the associated factors to achieve good clinical and angiographic outcomes.



Methods

The data were analyzed from 165 consecutive patients diagnosed as CS-dAVF from January 2005 to September 2018. The demographic data included approaching route, embolization times, embolization material, sequence of embolization, number of embolization sessions, and angiographic and clinical outcomes. Interrater agreement of bilateral CS-dAVF diagnosis was performed using the Kappa coefficient. The factors associated with treatment outcome were analyzed using Pearson’s χ2 test.



Results

Bilateral CS-dAVF was detected in 43 patients (26%). Angiographic presentations that showed evidence of sinus thrombosis, dangerous venous drainage, and higher Satomi classification were more commonly found in bilateral CS-dAVF than in unilateral CS-dAVF. Good clinical outcome and cure from angiography were obtained in 90% and 74%, respectively. Ipsilateral inferior petrosal sinus-intercavernous sinus-contralateral CS catheterization was the major approach route of treatment. The factors associated with improved clinical outcome were transvenous approach, shunt closure, coil embolization, and sequencing the embolization (P < 0.001).



Conclusions

Dangerous venous drainage tends to increase in bilateral CS-dAVF. Retrograde ipsilateral inferior petrosal sinus catheterization using coil embolization and sequencing the embolization are the major concerns for treatment.



Key words

Bilateral CS-dAVFAngiographic outcomeClinical outcomeEndovascular treatmentEfficiency of treatment

Abbreviations

S-dAVFcavernous sinus dural arteriovenous fistulaCScavernous sinusSOVsuperior ophthalmic veinIPSinferior petrosal sinusDSAdigital subtraction angiographyIOPintraocular pressureDVOdangerous venous outletSVOsymptomatic venous outletICSintercavernous sinus