Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Jun;47(3):100657.
doi: 10.1016/j.bj.2023.100657. Epub 2023 Sep 3.

Comparing transvenous coiling and transarterial embolization with Onyx/NBCA for cavernous sinus dural arteriovenous fistulas: A retrospective study in a single center

Yi-Ming Wu  1 , Chuan-Min Lin  2 , Sachin Giri  3 , Yao-Liang Chen  1 , Chien-Hung Chang  4 , Ho-Fai Wong  5
Affiliations
Comparative Study

Comparing transvenous coiling and transarterial embolization with Onyx/NBCA for cavernous sinus dural arteriovenous fistulas: A retrospective study in a single center

Yi-Ming Wu et al. Biomed J. 2024 Jun.

Abstract

Background: Endovascular management is the gold standard for cavernous sinus dural arteriovenous fistulas (CS-dAVFs) in patients with signs of ophthalmoplegia, visual defects, or intolerable clinical symptoms. Although the efficacy of embolization has been confirmed, complications during post-endovascular management have not been compared in a more extensive CS-dAVFs case series. Therefore, we compared the effectiveness and peri-procedural complications of transvenous coiling with those of transarterial embolization (TAE) using liquid embolic agents.

Methods: We reviewed 71 patients with CS-dAVFs in one medical center from 2005/7 to 2016/7. We performed seventy-seven procedures on 71 patients, including six recurrent cases. We compared the efficacy and peri-procedural complications of transvenous coiling and TAE.

Results: The complete occlusion rate for transvenous coiling was 79.2%, and that for TAE was 75.0%. Findings revealed (1) similar ophthalmoplegia complication rates (p = 0.744); (2) more frequent and permanent CN5 or CN7 neuropathy with liquid embolic agent use (p = 0.031 and 0.028, respectively); and (3) a higher risk of infarction or ICH (p = 0.002 and 0.028, respectively) in response to aggressive TAE.

Conclusion: Transvenous cavernous sinus coiling resulted in a similar occlusion rate and lower complication risk than transarterial Onyx/n-butyl cyanoacrylate (NBCA). We can access via an occluded inferior petrosal sinus (even contralateral), and direct transorbital puncture was a safe alternative. TAE with Onyx/NBCA was helpful in cases of oligo-feeders, but multidisciplinary treatment and multi-session TAE were usually needed for patients with multiple feeders and complex fistulas.

Keywords: Cavernous sinus dural arteriovenous fistulas; Coiling; Indirect carotid cavernous fistula; Inferior petrous sinus; Intensive NBCA/Onyx embolization.

PubMed Disclaimer

Conflict of interest statement

Disclosure. The authors report no conflicts of interest, no financial funding.

Figures

Fig. 1
Fig. 1
Algorithm for the endovascular treatment of CS-dAVFs.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62(2):248–256. - PubMed
    1. Ringer AJ, Salud L, Tomsick TA. Carotid cavernous fistulas: anatomy, classification, and treatment. Neurosurg Clin N Am. 2005;16(2):279–295. viii. - PubMed
    1. Biousse V, Mendicino ME, Simon DJ, Newman NJ. The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998;125(4):527–544. - PubMed
    1. Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009;29(1):62–71. - PubMed
    1. Tjoumakaris SI, Jabbour PM, Rosenwasser RH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am. 2009;20(4):447–452. - PubMed

Publication types

LinkOut - more resources