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Song Z, Su X, Ma Y, Rehem K, Fan Y, Yang C, Tu T, Zhang H, Ye M, Zhang P. Proposal of a Classification System of Cavernous Sinus Dural Arteriovenous Fistulas and Treatment Strategies Based on Angioarchitecture: A Cohort Study of 116 Patients. World Neurosurg 2024:S1878-8750(24)01000-3. [PMID: 38878890 DOI: 10.1016/j.wneu.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are commonly treated by transvenous embolization, but the details of treatment need to be more clearly defined. We propose a classification of CS-DAVF that can contribute to formulating endovascular treatment process. METHODS CS-DAVF was classified into seven categories based on the cumulative CS range and drainage patterns. CS-DAVF angioarchitecture, clinical characteristics, treatment strategies, and outcomes of CS-DAVF patients treated in our hospital from 2012 to 2021 were summarized and analyzed. RESULTS Among the 116 patients with CS-DAVF: Type 1, 71 (61.2%); Type 2, 9 (7.8%); Type 3, 18 (15.5%); Type 4, 2 (1.7%); Type 5, 8 (6.9%); Type 6, 3 (2.6%); and Type 7, 5 (4.3%). Inter-CS or inferior petrosal sinus drainage was relatively rare in Types 1 and 6 (P < 0.001 and P < 0.001); basilar venous plexus drainage was more prevalent in Types 2, 5, and 7(P = 0.019). Inferior petrosal sinus occlusion was more commonly seen in Types 2, 3, and 5 (P = 0.005). The most frequent first symptoms and symptoms at admission in patients with CS-DAVF is ocular/orbital symptoms, occurring in 64 cases (55.2%) and 104 cases (89.7%), respectively. In this study, 108 patients (93.1%) underwent endovascular embolization. Among those who received endovascular embolization, 96 (88.9%) CS-DAVFs were treated via transvenous embolization. In long-term follow-up, 98 cases (84.5%) achieved cure, and 17 cases (14.7%) showed symptomatic improvement. CONCLUSION Our proposed classification system based on cumulative CS range and drainage patterns can assist in formulating treatment strategies for transvenous embolization.
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Affiliation(s)
- Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Kheiser Rehem
- Department of Neurosurgery, Urumqi Friendship Hospital, Urumqi, China
| | - Yuxiang Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Chengbin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute(China-INI), Beijing, China.
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Iampreechakul P, Wangtanaphat K, Chuntaroj S, Angsusing C, Wattanasen Y, Hangsapruek S, Lertbusayanukul P, Siriwimonmas S. De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula. World Neurosurg X 2024; 22:100307. [PMID: 38496348 PMCID: PMC10943475 DOI: 10.1016/j.wnsx.2024.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Background The development of new dural arteriovenous fistulas (DAVFs) at another location following endovascular treatment of cavernous sinus DAVFs (CSDAVFs) are extremely rare. Our aim is to review cases of de Novo DAVFs that occurred after treatment of CSDAVFs at our institution and those reported in the literature. Methods We reviewed all cases of CSDAVFs evaluated by 2 experienced neuroradiologists. A literature search was performed using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines focusing on De Novo DAVFs following the endovascular treatment of cerebrovascular malformations. Addition articles were searched through the reference lists of the included articles. Results From June 2004 and September 2019., we identified 3 (2.5%) cases of De Novo DAVFs occurred after endovascular treatment or spontaneous obliteration of CSDAVFs from 119 treated CSDAVFs at our institute. Our review yielded 9 articles involving 12 patients with 15 de novo DAVFs, including our 3 patients. The mean age was 55.08 ± 12.9 years (range 43-69), 83.3% were females (n = 10). The new remote DAVFs occurred after endovascular treatment of CSDAVFs in 10 (83.3%) patients. The de novo DAVFs occurred following spontaneous complete regression in 2 (16.7%) patients. All de novo DAVFs developed after complete obliteration of treated CSDAVFs. Conclusion Sinus thrombosis and elevated venous pressure may play an important role in the pathogenesis of a de novo DAVF formation. In addition, thrombophilic abnormalities and the use of contraceptives may contribute to sinus thrombosis, leading to the development of the second remote DAVF after treatment of CSDAVFs.
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Affiliation(s)
| | | | - Songpol Chuntaroj
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Chonlada Angsusing
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Sunisa Hangsapruek
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
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Iampreechakul P, Wangtanaphat K, Chuntaroj S, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P, Siriwimonmas S. Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistula following partial transarterial embolization with liquid embolic material: Report of two cases. Surg Neurol Int 2023; 14:307. [PMID: 37810298 PMCID: PMC10559384 DOI: 10.25259/sni_594_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023] Open
Abstract
Background Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistulas (CSDAVFs) following partial transarterial embolization is an extremely uncommon phenomenon. The mechanism responsible for this condition remains unclear. Case Description The authors describe two cases of malignant CSDAVFs (Cognard IIb and V) treated by partial transarterial embolization with liquid embolic agents after unsuccessful transvenous embolization through various routes. Follow-up cerebral angiography in these cases confirmed complete resolution of the fistulas. Conclusion In our two patients harboring low-flow CSDAVFs with preexisting thrombosis of the cavernous sinus (CS), it is possible that some portions of the liquid embolic materials could migrate into the fistulas, inducing thrombosis within the CS.
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Affiliation(s)
| | | | - Songpol Chuntaroj
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Sunisa Hangsapruek
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
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Iampreechakul P, Liengudom A, Tirakotai W, Wangtanaphat K, Lertbutsayanukul P, Hangsapruek S, Siriwimonmas S. Combined endovascular and microsurgical management of complex traumatic carotid-cavernous fistula: Three case reports. Surg Neurol Int 2022; 13:337. [PMID: 36128157 PMCID: PMC9479571 DOI: 10.25259/sni_308_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/15/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
With the evolution of the endovascular devices, the management of endovascular interventions has become the current standard therapy for traumatic carotid-cavernous fistula (TCCF). However, only endovascular treatment may not be feasible in some patients with atypical TCCF.
Case Description:
We described three complex TCCFs that could not be managed by conventional endovascular methods. The first patient had recurrent TCCF previously treated by muscle embolization and ligation of affected carotid arteries 23 years ago. Another two patients had TCCFs association with large pseudoaneurysm within the sphenoid sinus. In each patient, the fistula was successfully closed by trapping procedure using a combination of endovascular and surgical treatment.
Conclusion:
To reduce costs of treatment, trapping operation by combining surgical and endovascular treatment may be considered as an alternative option for complex TCCF which has some features including chronic stage, preexisting carotid artery ligation, or association with large venous pouch of the cavernous sinus or sphenoid sinus pseudoaneurysm.
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