Complications associated with transvenous embolisation of cavernous dural arteriovenous fistula

Abstract

Results are presented of transvenous embolisation, via either the inferior petrosal sinus (IPS) or the superior ophthalmic vein (SOV), for 19 patients with cavernous dural arteriovenous fistula with special emphasis on complications. In 17 patients (89%) there was complete angiographic elimination of the shunts and resolution of the symptoms. The remaining two patients also improved clinically, regardless of the minimal residual shunts. Complications included forehead dysaesthesia in one patient, blepharoptosis in two, and transient abducens nerve palsy in three. Injury of the supra-orbital nerve and levator muscle occurred in association with the exposure of the SOV in the patient with dysaesthesia of the forehead and in those with blepharoptosis, respectively. In two patients, abducens nerve palsy resulted from coil over-packing in the cavernous sinus and from dissection of the clival dura during guidewire penetration of the thrombosed IPS in one patient. We found that the complication rate decreased with time, because we became better with this procedure. We believe that transvenous embolisation is the best available treatment modality if one pays careful attention to avoid complications related to the procedure.