HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) All Versions of this Article: jnnp.2006.100776v1 78/2/174    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Théaudin, M Articles by Houdart, E Search for Related Content PubMed PubMed Citation Articles by Théaudin, M Articles by Houdart, E

Diagnosis and treatment of dural carotid–cavernous fistulas: a consecutive series of 27 patients

¹ Service de Neurologie, Hôpital Lariboisière, Paris, France
² Service de Neuroradiologie, Hôpital Lariboisière, Paris, France
³ Service d’Ophtalmologie, Hôpital Lariboisière, Paris, France

Correspondence to:
Correspondence to:
E Houdart
Service de Neuroradiologie, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; emmanuel.houdart{at}lrb.aphp.fr

Objectives: To report clinical characteristics, angiographical findings and results of endovascular treatment of patients presenting with dural carotid–cavernous fistulas (DCCFs).

Method: Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department.

Results: Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic.

Conclusions: Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.

Abbreviations: DCCF, dural carotid–cavernous fistulas