title: Delayed abducens nerve palsy after transvenous coil embolization for cavernous sinus dural arteriovenous fistulae.
abstract: OBJECTIVE
  Abducens nerve palsy is the most common complication after transvenous embolization (TVE) for cavernous sinus dural arteriovenous fistula. Abducens nerve palsy is reported to have a good prognosis after the symptoms have been alleviated. The purpose of this study was to identify cases of delayed abducens nerve palsy after successful TVE and discuss the physiological mechanisms responsible for this unusual complication.
  
  
  METHODS
  Between 1991 and 2012, TVE was performed for 73 patients. The patients were evaluated for clinical symptoms every 12 months during the follow-up period. Patients' data and information about abducens nerve palsy were obtained from clinical records retrospectively.
  
  
  RESULTS
  Abducens nerve palsy newly developed in 4 (5.5%) of 73 patients at 3-65 months after TVE. All four patients with delayed abducens nerve palsy were followed up for 8-84 months. However, delayed abducens nerve palsy persisted in all four patients. In these four patients, the shunt points were posterior cavernous sinus. The average coil length used for four patients was 206.5 ± 43.1 cm (n = 4), and the average coil length used for patients without delayed abducens nerve palsy was 112.8 ± 38.8 cm (n = 69).
  
  
  CONCLUSIONS
  The possibility of delayed abducens nerve palsy should be kept in mind, especially in the patients who were treated with transvenous coil packing in the posterior part of the cavernous sinus. Furthermore, our results suggest that long-term follow-up care is important for these patients, even after complete neurological and radiological recovery was attained.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan, gktqx702@yahoo.co.jp.
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.forename: Naoya
authors.initials: N
authors.lastname: Kuwayama
authors.forename: Naoki
authors.initials: N
authors.lastname: Akioka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
mesh_terms: D020434:Abducens Nerve Diseases / Q000209:etiology*; D000368:Aged; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D002426:Cavernous Sinus / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome