Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients.
Details
Serval ID
serval:BIB_7A7E9CFEC0B4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients.
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN
1468-330X (Electronic)
ISSN-L
0022-3050
Publication state
Published
Issued date
02/2007
Peer-reviewed
Oui
Volume
78
Number
2
Pages
174-179
Language
english
Notes
Theaudin, M
Saint-Maurice, J-P
Chapot, R
Vahedi, K
Mazighi, M
Vignal, C
Saliou, G
Stapf, C
Bousser, M-G
Houdart, E
eng
England
2006/10/10 09:00
J Neurol Neurosurg Psychiatry. 2007 Feb;78(2):174-9. Epub 2006 Oct 6.
Publication types: Journal Article
Publication Status: ppublish
Saint-Maurice, J-P
Chapot, R
Vahedi, K
Mazighi, M
Vignal, C
Saliou, G
Stapf, C
Bousser, M-G
Houdart, E
eng
England
2006/10/10 09:00
J Neurol Neurosurg Psychiatry. 2007 Feb;78(2):174-9. Epub 2006 Oct 6.
Publication types: Journal Article
Publication Status: ppublish
Abstract
To report clinical characteristics, angiographical findings and results of endovascular treatment of patients presenting with dural carotid-cavernous fistulas (DCCFs).
Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department.
Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic.
Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.
Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department.
Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic.
Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.
Keywords
Adult, Aged, Aged, 80 and over, Carotid-Cavernous Sinus Fistula/diagnosis, Carotid-Cavernous Sinus Fistula/pathology, Carotid-Cavernous Sinus Fistula/therapy, Diagnosis, Differential, Embolization, Therapeutic, Female, Humans, Male, Middle Aged, Retrospective Studies, Thrombosis/etiology, Treatment Outcome
Pubmed
Create date
20/01/2017 16:30
Last modification date
20/08/2019 15:36