Abstract
AbstractPurpose This study was designed to compare ophthalmological symptoms of dural fistulas (DF) and carotid‐cavernous direct fistulas (CCF), before and after endovascular treatment, and to find out risk factors for ophthalmological sequelae.Methods We retrospectively studied 44 patients suffering from cavernous sinus fistulas with ophthalmologic symptoms, held in Lariboisière Hospital in Paris and Dupuytren Hospital in Limoges over 8 years. 24 patients had DF, 20 patients had CCF. 2 patients had spontaneous disappearance of the fistula, and 4 patients after non‐invasive treatment. The remaining 40 patients underwent endovascular treatment, until complete exclusion of the fistula (33 had a single treatment, and 5 had to be retreated)Results The main pre‐treatment symptoms were proptosis (n=38), episcleral venous congestion (n=31), oculomotor palsy (n=28), visual loss (n=20), glaucoma (n=17) and controlateral ocular symptoms (n=11). Thrill and murmur were more frequent in CCF (6 and 12) than in DF (0 and 5) (p<0,05). In patients with DF, the average age was greater (p<0,005) and glaucoma was more frequent (p=0,005). 14 patients had ophthalmological sequelae, oculomotor palsies in most cases (n=8). Ophthalmological sequelae were more frequent in patients with pre‐treatment visual impairement (p<0,05).Conclusion The risk of ophthalmological sequelae was higher in patients with pre‐treatment visual impairment, and lower in patients with complete anatomical cure of the fistula. 68% of patients had no ophthalmological sequelae after endovascular treatment, and 93,2% had no ophthlmological sequelae after specific additional medical treatment.
Published Version
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