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Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up.
Neuroradiol J. 2014 Sep; 27(4):461-70.NJ

Abstract

Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.

Authors+Show Affiliations

Neurology Department, Tabriz University of Medical Sciences; Tabriz, Iran - diako30@yahoo.com - mohammadianr@tbzmed.ac.ir.Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran.Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran.Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran.Neurology Department, Aalinasab Hospital; Tabriz, Iran.Ophthalmology Department, Tabriz University of Medical Sciences; Tabriz, Iran.Radiology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran.Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran.Neurology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran.Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran.Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

25196621

Citation

Pashapour, Ali, et al. "Long-Term Endovascular Treatment Outcome of 46 Patients With Cavernous Sinus Dural Arteriovenous Fistulas Presenting With Ophthalmic Symptoms. a Non-Controlled Trial With Clinical and Angiographic Follow-up." The Neuroradiology Journal, vol. 27, no. 4, 2014, pp. 461-70.
Pashapour A, Mohammadian R, Salehpour F, et al. Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. Neuroradiol J. 2014;27(4):461-70.
Pashapour, A., Mohammadian, R., Salehpour, F., Sharifipour, E., Mansourizade, R., Mahdavifard, A., Salehi, M., Mirzaii, F., Sariaslani, P., Ardalani, G. F., & Altafi, D. (2014). Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. The Neuroradiology Journal, 27(4), 461-70. https://doi.org/10.15274/NRJ-2014-10079
Pashapour A, et al. Long-Term Endovascular Treatment Outcome of 46 Patients With Cavernous Sinus Dural Arteriovenous Fistulas Presenting With Ophthalmic Symptoms. a Non-Controlled Trial With Clinical and Angiographic Follow-up. Neuroradiol J. 2014;27(4):461-70. PubMed PMID: 25196621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. AU - Pashapour,Ali, AU - Mohammadian,Reza, AU - Salehpour,Firooz, AU - Sharifipour,Ehsan, AU - Mansourizade,Reza, AU - Mahdavifard,Ali, AU - Salehi,Mohamadgharib, AU - Mirzaii,Farhad, AU - Sariaslani,Payam, AU - Ardalani,Ghasem Fatahzade, AU - Altafi,Davar, Y1 - 2014/08/29/ PY - 2014/05/26/received PY - 2014/07/10/accepted PY - 2014/9/9/entrez PY - 2014/9/10/pubmed PY - 2017/2/7/medline KW - cavernous sinus dural arteriovenous fistulas KW - endovascular treatment KW - long-term efficacy KW - transarterial approach KW - transvenous approach SP - 461 EP - 70 JF - The neuroradiology journal JO - Neuroradiol J VL - 27 IS - 4 N2 - Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms. SN - 1971-4009 UR - https://www.unboundmedicine.com/medline/citation/25196621/Long_Term_Endovascular_Treatment_Outcome_of_46_Patients_with_Cavernous_Sinus_Dural_Arteriovenous_Fistulas_Presenting_with_Ophthalmic_Symptoms__A_Non_Controlled_Trial_with_Clinical_and_Angiographic_Follow_up_ L2 - http://journals.sagepub.com/doi/full/10.15274/NRJ-2014-10079?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -