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RT Journal Article
SR Electronic
T1 Long-Term Outcome after Coil Embolization of Cavernous Sinus Arteriovenous Fistulas
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1216
OP 1221
DO 10.3174/ajnr.A2040
VO 31
IS 7
A1 Bink, A.
A1 Goller, K.
A1 Lüchtenberg, M.
A1 Neumann-Haefelin, T.
A1 Dützmann, S.
A1 Zanella, F.
A1 Berkefeld, J.
A1 du Mesnil de Rochemont, R.
YR 2010
UL http://www.ajnr.org/content/31/7/1216.abstract
AB BACKGROUND AND PURPOSE: Cranial nerve palsies are regularly observed in patients with arteriovenous fistulas of the cavernous sinus. The purpose of our study was to determine the long-term clinical outcome—with a special focus on extra-ocular muscular dysfunctions—in patients who had undergone endovascular treatment of a cavernous sinus fistula with detachable coils. MATERIALS AND METHODS: Sixteen patients were recalled for an ophthalmoneurologic control examination (mean interval of 4.4 years). The mRS and the EQ-5D questionnaire were used for the description of general outcome. Age, duration of symptoms, character of the fistula (direct, dural), and coil volume were tested to assess their relevance for persistent symptoms. RESULTS: All patients displayed complete regression of chemosis, exophthalmus, and pulsating tinnitus with no evidence of recurrences. Oculomotor disturbances persisted in 9 of 13 patients and caused permanent diplopia in 7 patients. In 15 patients a mRS score of 1 or 2 was achieved; however, 7 patients reported some limitations in life quality (EQ-5D). A significant correlation was found between coil volume and persistent diplopia (P = .032) and persistent cranial nerve VI paresis (P = .037). CONCLUSIONS: Coil embolization of the cavernous sinus led to durable closure of AVF and reliable regression of acute symptoms. However, long-term follow-up showed a 44% rate of persistent cranial nerve deficits with disturbances of oculomotor and visual functions. This may be explained by the underlying fistula size itself and/or the space-occupying effect of the coils. As neuro-ophthalmologic outcome is crucial for control of therapeutic success, patients should be routinely examined by ophthalmologists. AVFarteriovenous fistulaCNPcranial nerve palsiesCScavernous sinusICAinternal carotid arteryLRlikelihood ratiomRSmodified Rankin Scalenanot availableSOVsuperior ophthalmic vein