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Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review

  • Original Article - Vascular
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Abstract

Background

The long-term efficacy of endovascular treatment (EVT) for cavernous sinus dural arteriovenous fistulae (CS-dAVF) was assessed with a special focus on residual shunts after initial EVT.

Patients and methods

This retrospective survey included 50 patients who had undergone EVT and were followed for 1 month or longer (median follow-up 56 months).

Results

Common preoperative symptoms were chemosis (78%), extra-ocular motor palsy (72%), exophthalmos (66%), and tinnitus (26%). CS-dAVF were addressed by transvenous embolization (tVE, n = 48), tVE only was used in 43 instances and tVE plus transarterial embolization (tAE) in five. Two patients underwent tAE only. Procedure-related morbidity (brainstem infarction) was recorded in one patient (2%) and transient symptom exacerbation (paradoxical worsening) in 12 patients (24%). Postoperative digital subtraction angiography showed no major retrograde shunt or cortical venous reflux in any of the 50 patients. Anterograde or minor retrograde residual shunt was observed in 17 patients (34%); three of these underwent additional tVE and four had Gamma Knife surgery. The shunt flow disappeared in all 17 patients 12.6 ± 13.4 (mean ± SD) months after initial EVT. At the latest follow-up, 65.7 ± 52.6 months after the initial operation, no shunt flow was observed in any of the 50 patients. None had remaining or newly developed chemosis or tinnitus on follow-up. The rate of persistent cavernous sinus symptoms at the latest follow-up was higher in patients with than without post-procedural paradoxical worsening (5/12, 41.7% vs. 2/38, 5.3%, p = 0.0059 by Fisher’s exact test).

Conclusions

Long-term follow-up showed that EVT, especially tVE, is an efficient and safe treatment for CS-dAVF. It resulted in the eventual disappearance of shunt flow. Residual shunt without major retrograde flow or cortical venous reflux can be monitored without additional treatment.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

    Yosuke Nishimuta, Ryuji Awa, Sei Sugata, Ryosuke Hanaya, Hiroshi Tokimura, Hirofumi Hirano, F. M. Moinuddin, Muhammad Kamil, Akari Kibe & Kazunori Arita

  2. Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan

    Yosuke Nishimuta & Tetsuzo Tomosugi

  3. Department of Neurosurgery, Atsuchi Neurosurgery Hospital, Kagoshima, Japan

    Tetsuya Nagayama & Tsuneo Makiuchi

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  1. Yosuke Nishimuta
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  2. Ryuji Awa
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  11. Muhammad Kamil
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  12. Akari Kibe
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  13. Kazunori Arita
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Correspondence to Kazunori Arita.

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Ethical considerations

This retrospective study was approved by the Ethics Committee of Kagoshima University Hospital (reference No. 25–38, URL: http://com4.kufm.kagoshima-u.ac.jp/information/department/015/015–02.html). The authors certify that this study was conducted in accordance with the Helsinki Declaration (revised in 2000) and the Ethical Guidelines for Medical and Health Research Involving Human Subjects (effective February 9, 2015) promulgated by the Ministry of Health, Labor and Welfare, Japan. Informed consent for the treatment was obtained from all patients. Study-specific informed consent was waived due to the retrospective and noninvasive nature of the investigation using information contained in medical charts and records. An opt-out method was used. To protect patient privacy, all data were collected and analyzed under anonymization in an unlinkable fashion.

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Nishimuta, Y., Awa, R., Sugata, S. et al. Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review. Acta Neurochir 159, 2113–2122 (2017). https://doi.org/10.1007/s00701-017-3336-4

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  • DOI: https://doi.org/10.1007/s00701-017-3336-4

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