Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

Andrea M Alexandre, Carmelo Lucio Sturiale, Andrea Bartolo, Andrea Romi, Alba Scerrati, Maria Elena Flacco, Francesco D'Argento, Luca Scarcia, Giuseppe Garignano, Iacopo Valente, Emilio Lozupone, Alessandro Pedicelli, Andrea M Alexandre, Carmelo Lucio Sturiale, Andrea Bartolo, Andrea Romi, Alba Scerrati, Maria Elena Flacco, Francesco D'Argento, Luca Scarcia, Giuseppe Garignano, Iacopo Valente, Emilio Lozupone, Alessandro Pedicelli

Abstract

Purpose: Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs.

Methods: PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center.

Results: A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5-96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82-12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001).

Conclusion: A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.

Keywords: Carotico-cavernous d-AVF; Carotid-cavernous fistula; Cavernous sinus dural arteriovenous fistulas; DAVF; Endovascular treatment.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Search strategy flowchart
Fig. 2
Fig. 2
Different approaches for endovascular treatment of CS-dAVF. a Arterial approach, b transvenous through inferior petrosal sinus approach, c transvenous through superior ophthalmic vein approach, d direct puncture of the cavernous sinus through the superior ophthalmic fissure

References

    1. Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg. 1986;64:724–730. doi: 10.3171/jns.1986.64.5.0724.
    1. Debrun GM, Viñuela F, Fox AJ, Davis KR, Ahn HS. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery. 1988;22:285–289. doi: 10.1227/00006123-198802000-00001.
    1. Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: A systematic review. World J Radiol. 2013;5:143–155. doi: 10.4329/wjr.v5.i4.143.
    1. Meyers PM, Halbach VV, Dowd CF, Lempert TE, Malek AM, Phatouros CC, Lefler JE, Higashida RT. Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up. Am J Ophthalmol. 2002;134:85–92. doi: 10.1016/S0002-9394(02)01515-5.
    1. Klisch J, Huppertz HJ, Spetzger U, Hetzel A, Seeger W, Schumacher M. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature. Neurosurgery. 2003;53:836–856. doi: 10.1227/01.NEU.0000083551.26295.AB.
    1. Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009;29:62–71. doi: 10.1097/WNO.0b013e3181989fc0.
    1. Luo CB, Teng MM, Chang FC, Chang CY. Traumatic indirect carotid cavernous fistulas: angioarchitectures and results of transarterial embolization by liquid adhesives in 11 patients. Surg Neurol. 2009;71:216–222. doi: 10.1016/j.surneu.2007.09.032.
    1. Lv X, Jiang C, Li Y, Yang X, Wu Z. Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx. Interv Neuroradiol. 2008;14:415–427. doi: 10.1177/159101990801400407.
    1. Miller NR. Diagnosis and management of dural carotid-cavernous sinus fistulas. Neurosurg Focus. 2007;23:E13. doi: 10.3171/FOC-07/11/E14.
    1. Nishimuta Y, Awa R, Sugata S, Nagayama T, Makiuchi T, Tomosugi T, Hanaya R, Tokimura H, Hirano H, Moinuddin FM, Kamil M, Kibe A, Arita K. Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review. Acta Neurochir (Wien) 2017;159:2113–2122. doi: 10.1007/s00701-017-3336-4.
    1. Pashapour A, Mohammadian R, Salehpour F, Sharifipour E, Mansourizade R, Mahdavifard A, Salehi M, Mirzaii F, Sariaslani P, Ardalani GF, Altafi D. Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. Neuroradiol J. 2014;27:461–470. doi: 10.15274/NRJ-2014-10079.
    1. Satow T, Murao K, Matsushige T, Fukuda K, Miyamoto S, Iihara K. Neurosurgery. 2013;73(1):100–105.
    1. Yoshida K, Melake M, Oishi H, Yamamoto M, Arai H. Transvenous embolization of dural carotid cavernous fistulas: a series of 44 consecutive patients. AJNR Am J Neuroradiol. 2010;31:651–655. doi: 10.3174/ajnr.A1882.
    1. Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z. Transarterial and transvenous embolization for cavernous sinus dural arteriovenous fistulae. Interv Neuroradiol. 2010;16:269–277. doi: 10.1177/159101991001600307.
    1. Lee SH, Cho WS, Kang HS, Kim JE, Cho YD, Yoo DH, Han MH. Newly occurring cranial nerve palsy after endovascular treatment of cavernous sinus dural arteriovenous fistulas. J Neurointerv Surg. 2019;11:1168–1172. doi: 10.1136/neurintsurg-2018-014704.
    1. Rhim JK, Cho YD, Park JJ, Jeon JP, Kang HS, Kim JE, Cho WS, Han MH. Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula With Ipsilateral Inferior Petrosal Sinus Occlusion: A Single-Center Experience. Neurosurgery. 2015;77:192–199. doi: 10.1227/NEU.0000000000000751.
    1. Yu SC, Cheng HK, Wong GK, Chan CM, Cheung JY, Poon WS. Transvenous embolization of dural carotid-cavernous fistulae with transfacial catheterization through the superior ophthalmic vein. Neurosurgery. 2007;60:1032–1037. doi: 10.1227/01.NEU.0000255455.05355.31.
    1. Alexander MD, Halbach VV, Hallam DK, Cooke DL, Ghodke BV, Dowd CF, Amans MR, Hetts SW, Higashida RT, Meyers PM. Long-Term Outcomes of Endovascular Treatment of Indirect Carotid Cavernous Fistulae: Superior Efficacy, Safety, and Durability of Transvenous Coiling Over Other Techniques. Neurosurgery. 2019;85:E94–100. doi: 10.1093/neuros/nyy486.
    1. Ertl L, Brückmann H, Patzig M, Dorn F, Fesl G. Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas. PLoS One. 2020;15:e0231261. doi: 10.1371/journal.pone.0231261.
    1. Cha KC, Yeon JY, Kim GH, Jeon P, Kim JS, Hong SC. Clinical and angiographic results of patients with dural arteriovenous fistula. J Clin Neurosci. 2013;20:536–542. doi: 10.1016/j.jocn.2012.02.053.
    1. Cheng KM, Chan CM, Cheung YL. Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases. Acta Neurochir (Wien) 2003;145:17–29. doi: 10.1007/s00701-002-1013-7.
    1. de Castro-Afonso LH, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Colli BO, Velasco-E-Cruz AA, Abud DG. Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes. J Neurointerv Surg. 2018;10:461–462. doi: 10.1136/neurintsurg-2017-013318.
    1. Jiang C, Lv X, Li Y, Wu Z. Transvenous treatment of cavernous dural arteriovenous fistulae with onyx and coils. Neuroradiol J. 2008;21:415–422. doi: 10.1177/197140090802100319.
    1. Jia ZY, Song YS, Sheen JJ, Kim JG, Lee DH, Suh DC. Cannulation of Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: Usefulness of a Frontier-Wire Probing Technique. AJNR Am J Neuroradiol. 2018;39:2301–2306. doi: 10.3174/ajnr.A5868.
    1. Holland LJ, Ranzcr MK, Harrison JD, Brauchli D, Wong Y, Sullivan TJ. Endovascular treatment of carotid-cavernous sinus fistulas: ophthalmic and visual outcomes. Orbit. 2019;38:290–299. doi: 10.1080/01676830.2018.1544261.
    1. Griauzde J, Gemmete JJ, Pandey AS, Chaudhary N. Dural carotid cavernous fistulas: endovascular treatment and assessment of the correlation between clinical symptoms and the Cognard classification system. J Neurointerv Surg. 2017;9:583–586. doi: 10.1136/neurintsurg-2016-012418.
    1. Halbach VV, Hieshima GB, Higashida RT, Reicher M. Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol. 1987;149:587–593. doi: 10.2214/ajr.149.3.587.
    1. Alam MS, Jain M, Mukherjee B, Sharma T, Halbe S, Jaisankar D, Raman R. Visual impairment in high flow and low flow carotid cavernous fistula. Sci Rep. 2019;9:12872. doi: 10.1038/s41598-019-49342-3.
    1. Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am. 2005;16(viii):279–295. doi: 10.1016/j.nec.2004.08.004.
    1. Stiebel-Kalish H, Setton A, Nimii Y, Kalish Y, Hartman J, Bar-On HR, Berenstein A, Kupersmith MJ. Cavernous sinus dural arteriovenous malformations: patterns of venous drainage are related to clinical signs and symptoms. Ophthalmology. 2002;109:1685–1691. doi: 10.1016/S0161-6420(02)01166-1.
    1. Tjoumakaris SI, Jabbour PM, Rosenwasser RH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am. 2009;20:447–452. doi: 10.1016/j.nec.2009.07.013.
    1. Halbach VV, Higashida RT, Hieshima GB, Reicher M, Norman D, Newton TH. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology. 1987;163:437–442. doi: 10.1148/radiology.163.2.3562823.
    1. Higashida RT, Hieshima GB, Halbach VV, Bentson JR, Goto K. Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl. 1986;369:580–583.
    1. Nelson PK, Russell SM, Woo HH, Alastra AJ, Vidovich DV. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg. 2003;98:498–506. doi: 10.3171/jns.2003.98.3.0498.
    1. Cognard C, Januel AC, Silva NA, Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008;29:235–241. doi: 10.3174/ajnr.A0817.
    1. Alexandre AM, Visconti E, Lozupone E, D’Argento F, Pedicelli A. Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus Through Percutaneous Ultrasound-Guided Puncture of the Facial Vein. World Neurosurg. 2017;99(812):e13–20.
    1. Teng MM, Lirng JF, Chang T, Chen SS, Guo WY, Cheng CC, Shen WC, Lee LS. Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure. Radiology. 1995;194:705–711. doi: 10.1148/radiology.194.3.7862966.
    1. Workman MJ, Dion JE, Tong FC, Cloft HJ. Treatment of Trapped CCF by Direct Puncture of the Cavernous Sinus by Infraocular Trans-SOF Approach. Case Report and Anatomical Basis. Interv Neuroradiol. 2002;8:299–304. doi: 10.1177/159101990200800310.
    1. Fioravanti A, Fiaschi P, Badaloni F, Calbucci F. Transcranial approach for surgical-combined-endovascular treatment of a cavernous dural arteriovenous fistula: the superficial sylvian vein route. J Neurosurg Sci. 2020;64:405–407.
    1. Trivelato FP, Manzato LB, Filho PMM, Ulhôa AC, Vanzin JR, Abud DG, Rezende MTS. Transorbital Cavernous Sinus Direct Puncture: Alternative to treat dural arteriovenous fistula. Clin Neuroradiol. 2018;28:55–61.
    1. Benndorf G. Dural cavernous sinus fistulas. Diagnosis and endovascular therapy. Berlin, Heidelberg: Springer; 2010.
    1. Kim DJ, Kim DI, Suh SH, Kim J, Lee SK, Kim EY, Chung TS. Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management. AJNR Am J Neuroradiol. 2006;27:2078–2082.
    1. Nishino K, Ito Y, Hasegawa H, Kikuchi B, Shimbo J, Kitazawa K, Fujii Y. Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils. J Neurosurg. 2008;109:208–214. doi: 10.3171/JNS/2008/109/8/0208.
    1. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62:248–256. doi: 10.3171/jns.1985.62.2.0248.
    1. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194:671–680. doi: 10.1148/radiology.194.3.7862961.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera