Clinical manifestation and endovascular treatment of cavernous dural arteriovenous fistula

Abstract

Objective To explore the clinical symptoms, performance and efficacy of endovascular treatment of cavernous sinus dural arteriovenous fistula. Method 16 cases of cavernous dural arteriovenous fistula admitted in our department from January 2006 to May 2009 and the retrospective analysis of clinical data and symptoms, vascular intervention and curative effects were analyzed. Result There were 13 patients with congestive eyes (or the merger exophthalmos), one with exophthalmos, two with temporal noise, one with subarachnoid hemorrhage. Six patients were treated by NBCA embolization through arterial approach. Immediate embolization was achieved in 3 cases after fistula occlusion. There was residual fistula in 1 case but the symptoms disappeared after 2 months. And there was residual fistula in another 2 cases, but notable improvements in symptoms were observed. 8 cases were treated through a simple approach of vein thrombosis. 2 cases in which were treated by ONYX and coil embolization and complete fistula occlusion was observed. These 2 cases were associated with postoperative oculomotor nerve palsy and outreach, the symptoms were better after 1 month. 5 cases were treated through simple ONYX embolism. 1 case was performed through combined arterial and venous approach for embolization and complete fistula occlusion was achieved. 1 cases of a small fistula was performed by carotid artery compression and the fistula was observed to be smaller after 2 month. The postoperative complications of eyes were found in 3 patients: 1 ocular and oculomotor nerve palsy, 1 diplopia and outreach nerve palsy, 1 conjunctival hyperemia and eye pain. All the complications of eyes were all alleviated. Conclusions The clinical manifestations of cavernous sinus dural arteriovenous fistula are varied. Endovascular treatment is safe and effective. Through arterial embolization approach, the possibility rate of fistula occlusion is lower than that of the intravenous approach. But the incidence of postoperative complications of eyes of arterial approach is also lower. A higher rate of fistula occlusion is observed in intravenous approach, hut it should be paid attention to the prevention of eye complications. Key words: Arteriovenous fistula; Cavernous sinus; Postoperative complication