Abstract
We compared the results of transvenous and transarterial embolization of dural carotid-cavernous fistulas (dural CCFs). Seven patients with dural CCF were admitted to our clinic to undergo endovascular surgery. Five of them underwent transvenous embolizations alone with platinum coil. Complete disappearance of dural CCF was achieved intraoperatively in four of them and 5 months later in another. One patient underwent a transarterial embolization alone. Platinum coils were used in this patient because of positive provocative test in each feeding artery. The fistula was markedly decreased and occluded after one month. The seventh patient, in whom the fistula was partially occluded by the first transvenous approach, underwent a transarterial embolization by combination of the estrogen alcohol and polyvinyl acetate. But the fistula again recurred from a residual arterial feeder and it was finally occluded by the third transvenous approach. In summary, a successful intraoperative immediate occlusion of the fistula was achieved in 5 of 7 transvenous treatments and none in 2 transarterial treatments and complete cure was achieved finally in all patients. Two complications were related to these procedures. Necrosis of the soft palate followed an embolization of bilateral sphenopalatine arteries in one patient. The same patient had an asymptomatic migration of the platinum coil to the lung during a transvenous procedure. We concluded that transvenous embolization is a radical, safer alternative to the transarterial approach.
