Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63241, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Korean J Radiol. 2018 Mar-Apr;19(2):334-341. doi: 10.3348/kjr.2018.19.2.334. Epub 2018 Feb 22.
Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization.
Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment.
At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits.
With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.
双侧海绵窦硬脑膜动静脉瘘（CSdAVF）非常罕见，即使在亚洲国家也是如此。本研究旨在介绍通过血管内栓塞治疗此类瘘管的临床和影像学结果。
数据来自 2004 年 1 月至 2015 年 12 月期间连续 220 例 CSdAVF 患者。17 例（7.7%）患者确诊为双侧 CSdAVF。重点评估了治疗的技术方面，对瘘管的临床和影像学结果进行了评估。
在治疗时，7 例和 10 例患者分别表现出双侧和单侧症状。在前者中，4 例患者从单侧症状进展为双侧症状。15 例患者采用单阶段经静脉栓塞（TVE）治疗双侧瘘管，其中 9 例通过双侧岩下窦（IPS），6 例通过单侧 IPS。在另外 2 例具有分流优势的单侧患者中，仅治疗优势瘘管。在随访中，发现 2 例未治疗的病变在治疗对侧优势瘘管后已自发消退。在 34 个 CSdAVF 病变中，TVE 后有 32 个病变完全闭塞。7 例（41.2%）患者在 TVE 后出现颅神经麻痹恶化。在随访期间，4 例患者完全恢复，而另外 3 例仍存在缺陷。
通过调整血管内手术以适应不同的解剖结构，可以实现双侧 CSdAVF 的血管内治疗获得良好的血管造影闭塞结果。然而，在双侧 CSdAVF 中，TVE 后症状恶化可能经常发生。在具有分流优势的单侧患者中，仅治疗优势瘘管可能是另一种选择。
