Interventional Neuroradiology for Cavernous Dural Arterio-Venous Fistula with Special Reference to Indications and Approach

Abstract

Cavernous sinus dural arteriovenous fistula (CaDAVF) occurs most commonly in middle-aged women with an onset of symptoms characterized by ophthalmic manifestations (e.g., proptosis, chemosis, diplopia, ocular paresis).

We reviewed sixteen cases of CaDAVF experienced before 1992 and 29 cases experienced after 1992. There are a variety of treatments for CaDAVF depending upon the patient's clinical symptoms. Transarterial embolization (TAE), transvenous embolization (TVE), direct packing and radiotherapy are frequently chosen alternatives. On the basis of our clinical experience, endovascular intervention by TVE via the inferior petrosal sinus (IPS) is safe and effective.

Therefore, if radiological findings verify cortical venous reflux, aggressive treatment should be performed, even when the patient presents minimum symptoms, to eliminate the risk of venous infarction and/or intracranial hemorrhage. CaDAVF is a benign entity, and the therapeutic strategy should include a detailed analysis of the angioarchitecture and careful consideration of the condition of the individual patient.