Clinical study of main blood-supply cavernous sinus dural arteriovenous fistulas for embolization of the branches of external carotid artery with Onyx

Abstract

Objective To investigate the feasibility, complications and efficacy of main blood-supply cavernous sinus dural arteriovenous fistulas (CSDAVFs) for the embolization treatment of the branches of external carotid artery with Onyx via artery approach. Methods The clinical data and follow-up results of 15 patients (13 patients from the Neurointerventional Department of Beijing Tiantan Hospital and 2 patients from the Department of Neurosurgery, the Second Hospital of Yulin) treated with the main blood-supply CSDAVFs for the embolization treatment of the branches of external carotid artery with Onyx from August 2005 to October 2014 were analyzed retrospectively. Results Immediately after procedure, angiography revealed that 12 patients were embolized completely, 3 had partially residual fistula. The postoperative ocular symptoms of 14 patients were relieved, 3 complicated with ipsilateral facial numbness, one had facial paralysis, and one had diplopia. They were followed up for 3 to 24 months, angiographic findings revealed that 13 patients were cured completely, one had recurrence and received the second embolization, and the residue did not have any change in one case. The clinical follow-up showed that their ocular symptoms were all relieved, no hemorrhage was observed, and all the complications were relieved. Conclusions Microcatheter can reach CSDAVFs of fistula via the branches of external carotid artery approach. Onyx embolization of CSDAVFs is feasible. It is an alternative scheme which the microcatheter can not be in place via venous approach or after treatment failure. Key words: Meninges; Arteriovenous fistula; Cavernous sinus; Embolization, therapeutic