ABSTRACT
INTRODUCTION: It is hypothesized that a venographic-based operational classification of dural carotid-cavernous fistula (DCCF) will facilitate early selection of the optimal venous route and enhance the efficacy of transvenous catheterization and embolization of the cavernous sinus. METHODS: This was a retrospective study on 97 patients who presented with symptomatic DCCF. Definition of classification type 1: both the anterior and posterior compartments of the cavernous sinus were opacified, type 2: only the anterior compartment was opacified, type 3: only the posterior compartment was opacified. Subtype a: the facial vein (FV) draining the superior ophthalmic vein (SOV) was opacified, subtype b: only the inferior petrosal sinus (IPS) was opacified, subtype c: neither the FV nor the IPS were opacified, subtype d: both the FV and the IPS were opacified. The SOV route was recommended for subtype 1a and type 2. The IPS route was recommended for subtype 1b, 1c, 1d, and type 3. Success rates of catheterization by the recommended routes and non-recommended routes were calculated. RESULTS: Number of DCCF lesions were 20 (1a), 28 (1b), 23 (1c), 26 (1d), 16 (2a), 10 (2c), 2 (3b). Of 145 attempted catheterization, 91 and 54 were performed with a recommended route and un-recommended route, respectively. Success rate for catheterization and embolization performed with the recommended route and un-recommended route was 71/91 (78%) and 20/54 (37%), respectively (Chi-Square test P = 0.0024). CONCLUSIONS: Venographic operational classification is useful for guiding the selection of optimal venous route which enhances the efficacy of transvenous embolization of the DCCF.
Subject(s)
Carotid-Cavernous Sinus Fistula/diagnostic imaging , Carotid-Cavernous Sinus Fistula/therapy , Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/therapy , Embolization, Therapeutic/methods , Hemostatics/administration & dosage , Phlebography/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Injections, Intravenous , Male , Middle Aged , Radiography, Interventional/methods , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
BACKGROUND AND PURPOSE: Endovascular treatment with cyanoacrylate embolization is an option when complete obliteration of the nidus of an intracranial arteriovenous malformation (AVM) is the goal. Our purpose was to evaluate the rates of initial success and permanent cure of such treatment in a Chinese population. METHODS: Twenty-seven consecutive patients with an intracranial AVM underwent endovascular embolization with cyanoacrylate between June 1995 and May 1997. Twenty-six patients had cerebral AVMs and one had a cerebellar AVM. Curative embolization was attempted in 10 patients in whom 1) the nidus was not larger than 3 cm, 2) the number of feeders did not exceed three, and 3) the nidus was accessible with the tip of the catheter. We used a flow-directed microcatheter and a 20-25% mixture of cyanoacrylate in contrast medium. Long-term outcomes were observed angiographically and clinically. RESULTS: Complete embolization was achieved in six patients. No procedure-related complications occurred during attempted curative embolization. Follow-up angiography performed at 17-32 months showed complete obliteration of the AVM nidus in the six patients after initial embolization. These patients remained asymptomatic 5-7 years after treatment. The rate of permanent cure of the initially complete embolization was 100% (six of six). The success rate of endovascular cure for patients treated with curative intent was 60% (six of 10). The overall cure rate was 22% (six of 27). CONCLUSION: The overall initial cure rate of intracranial AVM with cyanoacrylate embolization was 22%. Initial angiographic evidence of complete embolization indicated permanent cure in these patients.
