Efficiency of Endovascular Therapy for Bilateral Cavernous Sinus Dural Arteriovenous Fistula.
BACKGROUND
The principles of endovascular treatment of bilateral cavernous sinus dural arteriovenous fistula (CS-dAVF) are not well established because of the complexity in the number of fistula tracts and their behavior, which seems to be more aggressive. We aimed to determine an efficient technique for endovascular treatment of bilateral CS-dAVF and the associated factors to achieve good clinical and angiographic outcomes.


METHODS
The data were analyzed from 165 consecutive patients diagnosed with CS-dAVF from January 2005 to September 2018. The demographic data included approaching route, embolization times, embolization material, sequence of embolization, number of embolization sessions, and angiographic and clinical outcomes. Interrater agreement of bilateral CS-dAVF diagnosis was performed using the κ coefficient. The factors associated with treatment outcome were analyzed using a Pearson χ2 test.


RESULTS
Bilateral CS-dAVF was detected in 43 patients (26%). Angiographic presentations that showed evidence of sinus thrombosis, dangerous venous drainage, and higher Satomi classification were more commonly found in bilateral CS-dAVF than in unilateral CS-dAVF. Good clinical outcome and cure from angiography were obtained in 90% and 74%, respectively. Ipsilateral inferior petrosal sinus-intercavernous sinus-contralateral cavernous sinus catheterization was the major approach route of treatment. The factors associated with improved clinical outcome were transvenous approach, shunt closure, coil embolization, and sequencing the embolization (P < 0.001).


CONCLUSIONS
Dangerous venous drainage tends to increase in bilateral CS-dAVF. Retrograde ipsilateral inferior petrosal sinus catheterization using coil embolization and sequencing the embolization are the major concerns for treatment.
['Churojana|Anchalee|A|', 'Sakarunchai|Ittichai|I|', 'Aurboonyawat|Thaweesak|T|', 'Chankaew|Ekawut|E|', 'Withayasuk|Pattarawit|P|', 'Sangpetngam|Boonrerk|B|']
D000368:Aged D001921:Brain D002426:Cavernous Sinus D020785:Central Nervous System Vascular Malformations D003392:Cranial Sinuses D004621:Embolization, Therapeutic D057510:Endovascular Procedures D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D016896:Treatment Outcome
Endovascular treatment Bilateral CS-dAVF Angiographic outcome Clinical outcome Efficiency of treatment