The Vascular Architecture of Cavernous Sinus Dural Arteriovenous Fistula and Its Impact on Endovascular Treatment Approach Selection and Outcome

Peixi Liu; Yingjun Liu; Yuan Shi; Qingzhu An; Wei Zhu; Yingtao Liu; Peiliang Li; Yanlong Tian

doi:10.1016/j.wneu.2022.07.094

The Vascular Architecture of Cavernous Sinus Dural Arteriovenous Fistula and Its Impact on Endovascular Treatment Approach Selection and Outcome

World Neurosurg. 2022 Oct:166:e770-e780. doi: 10.1016/j.wneu.2022.07.094. Epub 2022 Aug 3.

Authors

Peixi Liu¹, Yingjun Liu¹, Yuan Shi¹, Qingzhu An¹, Wei Zhu¹, Yingtao Liu², Peiliang Li¹, Yanlong Tian³

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
² Department of Radiology, Huashan Hospital of Fudan University, Shanghai, China.
³ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. Electronic address: yanlongtian@126.com.

PMID: 35933096
DOI: 10.1016/j.wneu.2022.07.094

Abstract

Background: A cavernous sinus (CS) dural arteriovenous fistula (DAVF) is a form of abnormal arteriovenous communication that can be treated with endovascular embolization. Establishing an optimal access route should be based on vascular architecture. We reviewed 64 patients with CS-DAVF who underwent endovascular embolization and report the endovascular treatment approach selection and outcome.

Methods: Clinical data were obtained from 64 patients with CS-DAVF who had been surgically treated at the authors' hospital between 2009 and 2022. Patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed.

Results: All 64 patients (15 male, 49 female; mean age, 50 years) underwent CS-DAVF embolization. The most common symptoms were exophthalmos (39.1%), chemosis (35.9%), and headache (28.1%). On digital subtraction angiography images, 34.4% of the DAVFs were unilateral, and 82.8% were fed by both the external carotid artery and internal carotid artery. Of the patients' inferior petrosal sinuses (IPSs), 54.7% were nonopacified. The most common intravascular approaches included trans-IPS (37.5%) and trans-artery (28.1%) approaches. More than half of the CS-DAVFs were embolized by both coils and Onyx (62.5%). A total of 85.9% of the fistulas were completely embolized, and the follow-up rate was 76.6%. The modified Rankin Scale score was 0.9 ± 1.0.

Conclusions: The vascular architecture of CS-DAVF is closely related to endovascular treatment approach selection and outcome. Combined with the modified IPS recanalization technique, the trans-IPS approach is the safest and most effective approach. Dual microcatheter and balloon assistance techniques ensure the safety and completeness of embolization.

Keywords: CS-DAVF; Embolization; Endovascular treatment; Surgical strategy; Vascular architecture.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Carotid Artery, Internal
Cavernous Sinus* / diagnostic imaging
Cavernous Sinus* / surgery
Central Nervous System Vascular Malformations* / diagnostic imaging
Central Nervous System Vascular Malformations* / surgery
Embolization, Therapeutic* / methods
Endovascular Procedures* / methods
Exophthalmos*
Female
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome