Abstract
Experiences with transvenous embolization for 22 cases of cavernous dural arteriovenous shunts are reported. All cases showed clinical symptoms related to their abnormal AV shunts. Among 25 sides of AV shunts, 3 cases showed bilateral AV shunts, 9 sides presented with bilateral external carotid (EC) and bilateral internal carotid (IC) arterial supply, 9 sides were fed by unilateral EC and unilateral IC arterial supply, 4 sides were fed by bilateral EC and unilateral IC supply, 2 sides showed unilateral EC and 1 side was supplied by unilateral IC. Anterior venous drainage was prominent in 16 sides which were treated by superior ophthalmic vein approach. Posterior drainage was prominent in other instances those were embolized via inferior petrosal vein approach. All procedures were carried out under local anesthesia using DSA monitoring. Copper wires were mainly used as embolic materials, while platinum coils and/or silk sutures served as adjunctive materials. Angiographical complete cure was achieved in 12 sides (48%) immediately, and in 19 sides (76%) at follow up ranging from 1 to 20 months after the embolization. Clinical symptoms were cleared or significantly reduced in all cases. Transarterial embolization, radiation or carotid compression therapy were required in one case each. Repeated transvenous embolization was performed in one case. Transient cavernous sinus syndrome were noted in 5 cases, posterior ischemic optic neuropathy due to diabetes mellitus, cerebral embolism after transarterial embolization were observed in one case each.
With modern technologies in mini-catheters and embolic materials, transvenous embolization should be considered as one of the most definite and safest method for the closure of cavernous dural arteriovenous shunts.
