Document Detail


Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas.
MedLine Citation:
PMID:  20299427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Andrea Bink; K Goller; M Lüchtenberg; T Neumann-Haefelin; S Dützmann; F Zanella; J Berkefeld; R du Mesnil de Rochemont
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Publication Detail:
Type:  Journal Article     Date:  2010-03-18
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  31     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-13     Completed Date:  2010-11-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1216-21     Citation Subset:  IM    
Affiliation:
Department of Neuroradiology, Goethe-University, Frankfurt/Main, Germany. andrea.bink@kgu.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arteriovenous Fistula / complications*,  radiography,  therapy*
Carotid-Cavernous Sinus Fistula / complications*,  radiography,  therapy*
Cerebral Angiography
Cranial Nerve Diseases / etiology
Embolization, Therapeutic*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Quality of Life
Questionnaires
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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