[Dural fistula of the cavernous sinus. Clinical and angiographic aspects. Results of particulate intravascular treatment].
Thirteen patients with dural fistula of the cavernous sinus were studied by angiography. Nine of them presented with ophthalmic symptoms (chemosis and oculomotor disorders caused by the fistula). In one patient the lesion was discovered by chance, and 2 other patients had consulted for a disabling tinnitus. Eight patients accepted to the treated by the endovascular route for embolization of the maxillary artery, using particles. Embolization was unilateral in 4 cases and bilateral in 4 other cases. All embolizations were followed by serial control angiography immediately performed. All subjects were seen again as out-patients at 3 month, and 5 of them accepted a control angiography. Three patients were then regarded as clinically and anatomically cured. Two patients with incomplete clinical and angiographic results had a second embolization which resulted in clinical and anatomical cure at a 4-month control examination. These 8 patients were re-examined clinically after one month of treatment and found to be symptomless. Only one complication (transient oedema of the face) was noted. Dural fistulae are lesions that are most probably acquired by alteration of the physiological dural arteriovenous shunts occurring soon after venous thrombosis. Their course is capricious, and they sometimes heal spontaneously. However, the cavernous sinus location with its repercussion on the eye usually requires treatment. This treatment is initially endovascular; surgery and multifascicular irradiation being reserved for failures. Particle embolization of maxillary arteries is a simple and efficient procedure which must be used initially. If it proves insufficient, embolization of other arterial feeders (but it is often more dangerous) or the venous route can be tried.
Sonier
C B
CB
Service de Neuroradiologie, CHU de Tours.
De Kersaint-Gilly
A
A
Viarouge
M P
MP
Auffray-Calvier
E
E
Cottier
J P
JP
Laffont
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002426:Cavernous Sinus / Q000473:pathology*; D003229:Conjunctival Diseases / Q000209:etiology; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008438:Maxillary Artery; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000209:etiology; D013924:Thrombophlebitis / Q000150:complications; D014012:Tinnitus / Q000209:etiology