title: Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up.
abstract: Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.
authors.affiliation: Neurology Department, Tabriz University of Medical Sciences; Tabriz, Iran - diako30@yahoo.com - mohammadianr@tbzmed.ac.ir.
authors.forename: Ali
authors.initials: A
authors.lastname: Pashapour
authors.affiliation: Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Mohammadian
authors.affiliation: Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran.
authors.forename: Firooz
authors.initials: F
authors.lastname: Salehpour
authors.affiliation: Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Sharifipour
authors.affiliation: Neurology Department, Aalinasab Hospital; Tabriz, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Mansourizade
authors.affiliation: Ophthalmology Department, Tabriz University of Medical Sciences; Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Mahdavifard
authors.affiliation: Radiology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran.
authors.forename: Mohamadgharib
authors.initials: M
authors.lastname: Salehi
authors.affiliation: Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Mirzaii
authors.affiliation: Neurology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran.
authors.forename: Payam
authors.initials: P
authors.lastname: Sariaslani
authors.affiliation: Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran.
authors.forename: Ghasem Fatahzade
authors.initials: GF
authors.lastname: Ardalani
authors.affiliation: Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran.
authors.forename: Davar
authors.initials: D
authors.lastname: Altafi
mesh_terms: D000293:Adolescent; D000328:Adult; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D004487:Edema / Q000209:etiology; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D057510:Endovascular Procedures / Q000379:methods; D005128:Eye Diseases / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D014014:Tissue Adhesives / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate
keywords: cavernous sinus dural arteriovenous fistulas; endovascular treatment; long-term efficacy; transarterial approach; transvenous approach