Transvenous embolization of dural carotid cavernous fistulas: a series of 44 consecutive patients.
OBJECTIVE
Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.


METHODS
We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.


RESULTS
An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6-40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).


CONCLUSIONS
For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.
Yoshida
K
K
Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan. kyoshida@juntendo.ac.jp
Melake
M
M
Oishi
H
H
Yamamoto
M
M
Arai
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome