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Bilateral Cavernous Sinus Dural Arteriovenous Fistulae

The Strategies for Endovascular Treatment

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Abstract

Purpose

Most cavernous sinus dural arteriovenous fistulas (CSDAVF) are unilateral; however, simultaneous bilateral CSDAVFs occasionally may be found. This article reports on 141 patients and compares the angioarchitecture and outcomes of embolization of bilateral CSDAVFs with those of unilateral CSDAVFs, with reference to limited demographics (sex and age) of the patients.

Method

From January 2010 to February 2018 a total of 141 consecutive patients with CSDAVFs were referred for transvenous embolization. Bilateral CSDAVFs were found in 20 patients (14.2%, with a mean age of 62.2 years). The angioarchitecture of the 141 patients with CSDAVFs were evaluated by conventional cerebral angiography. We compared the angioarchitecture and treatment outcomes of 20 bilateral and 121 unilateral CSDAVFs, and in relation to the patients’ sex and age.

Results

Female patients significantly dominated the bilateral CSDAVFs (90%, p = 0.043). Bilateral eye symptoms were significantly more common in bilateral CSDAVFs (p = 0.011), with dominant orbital and cavernous symptoms, and showed statistical significance (p = 0.049 and 0.011, respectively). Occlusion of one CSDAVF may significantly decrease the fistula flow of the other untreated side (n = 13, 65%), leading to less coil utilization for embolization in bilateral CSDAVFs (p < 0.001). There was no statistical significance in the occurrence of occlusion of the inferior petrous sinus(s), in pial vein reflux, and treatment outcomes in the unilateral and bilateral CSDAVFs.

Conclusion

Bilateral CSDAVFs were more dominant in female patients and frequently presented with orbital and cavernous symptoms. Fewer coils were used per lesion in the bilateral CSDAVFs. There was no statistical significance in bilateral and unilateral CSDAVFs in terms of impact of venous drainage, pial vein reflux and treatment outcomes.

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Funding

This study was funded by Taipei Veterans General Hospital (grant number: V107C-170, 023) and the Ministry of Science and Technology (grant number: MOST-106-2314B-075-011).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Li-Yu Fay & Jau-Ching Wu

  2. School of Medicine, National Yang Ming University, Taipei, Taiwan

    Li-Yu Fay, Chao-Bao Luo, Liang-Wei Chen, Jau-Ching Wu, Feng-Chi Chang & Chung-Jung Lin

  3. Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan

    Li-Yu Fay & Jau-Ching Wu

  4. Department of Radiology, Taipei Veterans General Hospital, 2F, No. 201, Section 2, Shi-Pai Road, 11217, Taipei, Taiwan

    Chao-Bao Luo, Liang-Wei Chen, Feng-Chi Chang & Chung-Jung Lin

  5. Department of Radiology, Tri-Service General Hospital and National Defenses Medical center, Taipei, Taiwan

    Chao-Bao Luo

  6. Department of Radiology, National Yang-Ming University, Taipei, Taiwan

    Chao-Bao Luo, Liang-Wei Chen, Feng-Chi Chang & Chung-Jung Lin

  7. Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Chieh-Hsin Wu

  8. Department of Surgery, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chieh-Hsin Wu

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  1. Li-Yu Fay
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Correspondence to Chao-Bao Luo.

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Conflict of interest

L.-Y. Fay, C.-B. Luo, L.-W. Chen, J.-C. Wu, C.-H. Wu, F.-C. Chang and C.-J. Lin declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Fay, LY., Luo, CB., Chen, LW. et al. Bilateral Cavernous Sinus Dural Arteriovenous Fistulae. Clin Neuroradiol 31, 165–172 (2021). https://doi.org/10.1007/s00062-019-00868-z

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  • DOI: https://doi.org/10.1007/s00062-019-00868-z

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