Endovascular management of dural carotid–cavernous sinus fistulas in 141 patients
Tóm tắt
Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid–cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid–cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Results: Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. Conclusion: The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid–cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved.
Tài liệu tham khảo
Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT (1985) Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 62:248–256
Newton TH, Cronqvist S (1969) Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078
Vinuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG (1984) Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60:976–984
Sasaki H, Nukui H, Kaneko M, Mitsuka S, Hosaka T, Kakizawa T, Kimura R, Nagaseki Y, Naganuma H (1988) Long-term observations in cases with spontaneous carotid-cavernous fistulas. Acta Neurochir 90:117–120
Newton TH, Hoyt WF (1970) Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1:71–81
Higashida RT, Hieshima GB, Halbach VV, Bentson JR, Goto K (1986) Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl 369:580–583
Halbach VV, Hieshima GB, Higashida RT, Reicher M (1987) Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol 149:587–593
Sarma D, ter Brugge K (2003) Management of intracranial dural arteriovenous shunts in adults. Eur J Radiol 46:206–220
Van Dijk JM, ter Brugge KG, Willinsky RA, Wallace MC (2002) Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 33:1233–1236
Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R (1997) Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 40:1119–1132
Cheng KM, Chan CM, Cheung YL (2003) Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases. Acta Neurochir 145:17–29
Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Pribram H (1989) Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol 10:377–383
Miller NR, Monsein LH, Debrun GM, Tamargo RJ, Nauta HJ (1995) Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83:838–842
Quinones D, Duckwiler G, Gobin PY, Goldberg RA, Vinuela F (1997) Embolization of dural cavernous fistulas via superior ophthalmic vein approach. AJNR Am J Neuroradiol 18:921–928
Yamashita K, Taki W, Nishi S, Sadato A, Nakahara I, Kikuchi H, Yonekawa Y (1993) Transvenous embolization of dural caroticocavernous fistulae: technical considerations. Neuroradiology 35:475–479
Mullan S (1979) Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50:131–144
Hosobuchi Y (1975) Electrothrombosis of carotid-cavernous fistula. J Neurosurg 42:76–85
Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Pribram H (1989) Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol 10:377–383
Takahashi A, Yoshimoto T, Kawakami K, Sugawara T, Suzuki J (1989) Transvenous copper wire insertion for dural arteriovenous malformations of cavernous sinus. J Neurosurg 70:751–754
Teng MM, Guo WY, Huang CI, Wu CC, Chang T (1988) Occlusion of arteriovenous malformations of the cavernous sinus via the superior ophthalmic vein. AJNR Am J Neuroradiol 9:539–546
Halbach VV, Dowd CF, Higashida RT, Hieshima GB (1997) Transvenous coil treatment of CCF. In: Tomsick TA (ed) Carotid cavernous fistula. Digital Educational Publishing, Cincinnati, pp 163–175
Meyers PM, Halbach VV, Dowd CF, Lempert TE, Malek AM, Phatouros CC, Lefler JE, Higashida RT (2002) Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up. Am J Ophthalmol 134:85–92
Oishi H, Arai H, Sato K, Iizuka Y (1999) Complications associated with transvenous embolisation of cavernous dural arteriovenous fistula. Acta Neurochir 141:1265–1271
Yamashita K, Taki W, Nishi S, Sadato A, Nakahara I, Kikuchi H, Yonekawa Y (1993) Transvenous embolization of dural caroticocavernous fistulae: technical considerations. Neuroradiology 35:475–479