Trans-arterial embolisation therapy of dural carotid-cavernous fistulae using low concentration n-butyl-cyanoacrylate.
BACKGROUND
Trans-venous embolisation has been accepted as the preferred treatment for dural carotid-cavernous fistulae (DCCF). However, such an approach is not always feasible. In this circumstance, trans-arterial embolisation with low concentration n-butyl-cyanoacrylate glue (NBCA) may be a feasible alternative. We report our results and experience of this method for DCCF.


METHODS
Five patients with DCCF were treated by trans-arterial embolisation using low concentration NBCA by wedging the microcatheter into the main feeding artery. All five lesions were associated with venous drainage into the superior ophthalmic vein. The inferior petrosal sinus was patent in one patient and thrombosed in four. Additional venous drainage into the Sylvian vein and the superior petrosal sinus was observed in two patients.


RESULTS
The definitive NBCA injection was performed via the branches of the middle meningeal artery in three patients and accessory meningeal artery as well as ascending pharyngeal artery in two patients. Four patients showed complete obliteration of the DCCF on the post-embolisation angiogram, and follow-up studies showed clinical cure or improvement and successful obliteration of the DCCF. One patient had a residual DCCF after the procedure, but showed complete obliteration and clinical cure at 5-month follow-up. Glue penetrated into the Sylvian vein in one patient during the procedure without sequelae. Two patients had transient worsening of ocular symptoms after the procedure.


CONCLUSIONS
Trans-arterial embolisation with low concentration NBCA using a wedged microcatheter technique is still a safe and effective treatment for DCCF when the transvenous approach is not feasible. However, care must be taken to prevent inadvertent arterial and venous embolisation.
Li
Ming-Hua
MH
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, 600, Yi Shan Road, Shanghai, 200233, China.
Tan
Hua-Qiao
HQ
Fang
Chun
C
Zhu
Yue-Qi
YQ
Wang
Wu
W
Wang
Jue
J
Cheng
Ying-Sheng
YS
D000269:Adhesives / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000033:anatomy & histology / Q000473:pathology; D020216:Carotid-Cavernous Sinus Fistula / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002404:Catheterization / Q000592:standards; D002426:Cavernous Sinus / Q000033:anatomy & histology / Q000473:pathology; D002550:Cerebral Veins / Q000033:anatomy & histology / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008438:Maxillary Artery / Q000033:anatomy & histology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome
D000269:Adhesives; D004659:Enbucrilate