Interventional neuroradiology in neuro-ophthalmology

Abstract

Endovascular neuroradiologic procedure is the treatment of choice for patients with symptomatic direct carotid cavernous fistulae (CCF) and dural arteriovenous fistulae (DAVF) that failed manual carotid artery/jugular vein compression. Preservation of visual function and the prevention of catastrophic intracranial hemorrhage are the prime therapeutic objectives. The choice of transarterial versus transvenous approach is dictated by the pathophysiology, pattern of venous drainage, and the risk/benefit ratio in each patient. In 180 patients with CCF, 95% have been cured with a combination of manual compression, transarterial or transvenous embolization, while 3% have significant complication. In patients with DAVF, transarterial and transvenous embolization has resulted in clinical cure in 77 and 90%, respectively; the complication rate is between 4-5%. Intra-aneurysmal embolization with silicone detachable balloons in its present stage of development is an acceptable alternative for patients with intracranial aneurysms not otherwise amenable to standard neurosurgical clipping. In aneurysms with a well-defined neck, aneurysm thrombosis with preservation of flow in the parent vessel has been accomplished in 90% of the patients treated. The complication rate in patients presenting with mass effect and subarachnoid hemmorrhage is 5 and 14%, respectively.