Endovascular management of cavernous sinus dural arteriovenous fistula: A single-center experience

Objective: The purpose of this study was to evaluate the single-center experience with endovascular management of cavernous sinus dural arteriovenous fistula (CS-DAVF). Methods: From October 2018 to April 2020, a total of 54 patients with CS-DAVF underwent endovascular treatment at our center. Demographic information, clinical symptoms, and lesion characteristics were noted. Medical records were reviewed to assess changes in clinical status, complications, and recurrence following treatment. The correlation between patient characteristics, fistula characteristics, and treatment outcomes was analyzed. Results: Clinical signs and symptoms included chemosis (81.5%), exophthalmos (42,6%), cranial nerve palsy/ diplopia (11.1%), increased intraocular pressure (74.1%), and impaired vision (42,6%). Cortical venous drainage was identified in 29.6% of the patients. Transvenous embolization (alone or in conjunction with transarterial embolization) was the treatment of choice in most patients. Partial transarterial embolization alone was carried out in only 1.8%. Complete occlusion of the fistula was achieved in 81.48%, near complete occlusion (without cortical venous drainage or ocular drainage) was achieved in 18.52%. After complete occlusion of the fistula, no recurrence was observed. Conclusion: Transvenous embolization is a highly efficient and safe treatment for CS-DAVF. In a majority of patients, a significant and permanent improvement in clinical signs and symptoms can be achieved.