Safety and Efficacy of Different Approaches for the Interventional Therapy of Cavernous Sinus Dural Arteriovenous Fistula
YANG Zijian, FANG Wei, ZHAO Zhenwei, ZHANG Tao, LUO Guoqiang, XING Zifei, LIU Haitao, GUO Xing, DENG Jianping
2024, 19(11):
1288-1295.
DOI: 10.3969/j.issn.1673-5765.2024.11.005
Asbtract
(
)
PDF (3862KB)
(
)
References |
Related Articles |
Metrics
Objective To explore the safety and efficacy of interventional therapy of cavernous sinus dural arteriovenous fistulas (CS-DAVF) with different approaches and strategies.
Methods Retrieve the prospective vascular disease database of the Vascular Disease Center, Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University. Data from all patients with CS-DAVF who attempted interventional therapy from January 2013 to December 2022 were retrospectively analyzed. All information including patients’ general data, clinical symptoms and signs, imaging data, surgical information, and follow-up results were collected. The data was summarized and analyzed.
Results A total of 71 patients with CS-DAVF attempted interventional therapy. Among them, 54 cases (76.1%) presented with ocular symptoms as the main sign, including decreased vision, chemosis, exophthalmos, limited movement, and ptosis. Sixty-six patients (93.0%) successfully completed the operation, with transvenous approach in 40 cases (60.6%), transarterial approach in 21 cases (31.8%), and combined arteriovenous approach in five cases (7.6%). Onyx was combined with coil in 29 cases (43.0%), Onyx alone in 36 cases (54.5%), and coil alone in one case (1.5%). DSA immediately after embolization showed complete occlusion in 57 cases (86.4%) and subtotal occlusion in nine cases (13.6%). Univariate logistic regression analysis showed that surgical approach [adjusted OR (aOR) 3.854, 95%CI 0.821-18.101, P=0.087＜0.1] and Onyx combined with coil (aOR 8.282, 95%CI 0.972-70.617, P=0.053＜0.1) were related to the critical cure rate.
Surgery-related complications occurred in 19 patients (28.8%), among of them, 15 were with new or worsened exist ocular symptoms, two were with facial paresthesia, and two were with neurological dysfunction affecting limb movement. Univariate logistic regression analysis results showed that surgical complications were not correlated with various influencing factors. Sixty-five patients (98.5%) completed one-year clinical follow-up. Among the 19 patients with surgical complications, 16 cases completely disappeared, two cases improved, one case lost follow-up, and the original symptoms of the remaining patients completely disappeared except for one case who still had diplopia. Forty patients (60.6%) were followed up with DSA, and no recurrence was reported.
Conclusions The transvenous approach is more advantageous than the transarterial approach in the interventional therapy of CS-DAVF, and the inferior petrosal sinus approach can be the first choice. The use of transvenous approach and Onyx combined with coil is related to the critical cure rate. The efficacy is considerable. Although some patients have complications, the majority of patients are transient surgical complications, and satisfactory clinical efficacy can be obtained.
