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Spontaneous angiographic changes in venous drainage patterns related to symptom changes in patients with untreated cavernous sinus dural arteriovenous fistula

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

We evaluated the relationship between symptomatic and angiographic changes in untreated cavernous sinus dural arteriovenous fistulas (CSdAVFs), focusing on venous drainage patterns.

Methods

The clinical and radiologic features of 34 cases of untreated CSdAVF were retrospectively reviewed. We classified venous drainage patterns as type I (only antegrade drainage), type II (combined antegrade drainage and venous reflux), type III (venous reflux without antegrade drainage), or type IV (stasis or occlusion of venous reflux). Symptom changes were categorized as improvement, aggravation of initial symptoms, or symptom pattern change.

Results

Twenty-one patients (61 %) showed symptom changes during follow-up (median, 12; range, 3–151 months). In the symptom improvement group (n = 10), patients who underwent follow-up angiography (n = 4) exhibited spontaneous occlusion. In the symptom aggravation group (n = 4), new venous reflux developed in 2 patients (type I to type II) and spontaneous occlusion in 2 patients (type III to spontaneous occlusion). In the symptom pattern change group (n = 7), 2 patients showed new venous reflux (type I to type II), and 5 showed stasis or occlusion of an engorged ophthalmic vein (type II or III to type IV). Angiographic regression was observed in all type III and IV patients, and cortical venous reflux (CVR) developed in 1 type I patient.

Conclusion

Symptom changes correlated with chronological angiographic changes. Without treatment, most CSdAVFs behaved benignly and had a low incidence of CVR. Therefore, close observation is a possible protocol for managing CSdAVFs that have tolerable symptoms, no CVR, and no antegrade drainage despite aggravation or fluctuation in symptoms.

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Abbreviations

CSdAVF:

Cavernous sinus dural arteriovenous fistula

CVR:

Cortical venous reflux

IPS:

Inferior petrosal sinus

SPS:

Superior petrosal sinus

OV:

Ophthalmic vein

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Authors and Affiliations

  1. Department of Neurosurgery, Bundang Jesaeng Hospital, Sungnam, Korea

    Jai Ho Choi

  2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea

    Keon Ha Kim & Pyoung Jeon

  3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Kyung Il Jo, Je Young Yeon, Jong Soo Kim & Seung Chyul Hong

Authors
  1. Jai Ho Choi
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  2. Kyung Il Jo
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  3. Keon Ha Kim
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  4. Pyoung Jeon
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  6. Jong Soo Kim
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  7. Seung Chyul Hong
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Corresponding author

Correspondence to Pyoung Jeon.

Ethics declarations

We declare that all human and animal studies have been approved by the Institutional Review Board of Samsung Medical Center (No. SMC 2015-02-103-001) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

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We declare that we have no conflict of interest.

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Choi, J.H., Jo, K.I., Kim, K.H. et al. Spontaneous angiographic changes in venous drainage patterns related to symptom changes in patients with untreated cavernous sinus dural arteriovenous fistula. Neuroradiology 57, 1153–1161 (2015). https://doi.org/10.1007/s00234-015-1597-2

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  • DOI: https://doi.org/10.1007/s00234-015-1597-2

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