Coil embolization of cavernous sinus in patients with direct and dural arteriovenous fistula |
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Authors: | Andrea Bink Joachim Berkefeld Marc Lüchtenberg Rüdiger Gerlach Tobias Neumann-Haefelin Friedhelm Zanella Richard du Mesnil de Rochemont |
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Institution: | (1) Department of Neuroradiology, Goethe University, Schleusenweg 2-16, Haus 95, 60528 Frankfurt am Main, Germany;(2) Department of Ophthalmology, Goethe University, Frankfurt/Main, Germany;(3) Department of Neurosurgery, Goethe University, Frankfurt/Main, Germany;(4) Department of Neurology, Goethe University, Frankfurt/Main, Germany |
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Abstract: | To determine technical success and acute complication rates after endovascular coil packing of the cavernous sinus. Nineteen
patients presented with either direct (13) or dural (6) arteriovenous fistula (AVF) and were treated by means of coil embolization
of the cavernous sinus. The aim of treatment was complete obliteration of the fistula. In a retrospective study, the degree
of obliteration, regression of symptoms as well as complication rates were evaluated. Initial complete obliteration was achieved
in 12 patients, subtotal occlusion of the sinus in 6 and incomplete packing with major residual fistula in 1 of the patients.
Retreatment was successfully performed in two patients with early recurrence of AVF. Follow-up showed complete occlusion rates
in 16 and subtotal obliteration in 3 patients. Chemosis and exophthalmus regressed rapidly in all affected patients. Persistence
of cranial nerve deficits was observed in 11 cases. Postinterventional thrombosis of the ophthalmic vein was the only major
acute complication (n = 2). Coil embolization of the cavernous sinus in cases with AVF is a complex procedure that is technically
feasible and safe in the majority of cases. Adequate anticoagulation is recommended to avoid thrombembolic complications.
Long-term outcome has to be determined by further studies. |
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Keywords: | Cavernous sinus Fistula Direct AVF Dural arteriovenous fistula Coil Embolization |
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