Abstract:
INTRODUCTION:We evaluated the relationship between symptomatic and angiographic changes in untreated cavernous sinus dural arteriovenous fistulas (CSdAVFs), focusing on venous drainage patterns. METHODS:The clinical and radiologic features of 34 cases of untreated CSdAVF were retrospectively reviewed. We classified venous drainage patterns as type I (only antegrade drainage), type II (combined antegrade drainage and venous reflux), type III (venous reflux without antegrade drainage), or type IV (stasis or occlusion of venous reflux). Symptom changes were categorized as improvement, aggravation of initial symptoms, or symptom pattern change. RESULTS:Twenty-one patients (61 %) showed symptom changes during follow-up (median, 12; range, 3-151 months). In the symptom improvement group (n = 10), patients who underwent follow-up angiography (n = 4) exhibited spontaneous occlusion. In the symptom aggravation group (n = 4), new venous reflux developed in 2 patients (type I to type II) and spontaneous occlusion in 2 patients (type III to spontaneous occlusion). In the symptom pattern change group (n = 7), 2 patients showed new venous reflux (type I to type II), and 5 showed stasis or occlusion of an engorged ophthalmic vein (type II or III to type IV). Angiographic regression was observed in all type III and IV patients, and cortical venous reflux (CVR) developed in 1 type I patient. CONCLUSION:Symptom changes correlated with chronological angiographic changes. Without treatment, most CSdAVFs behaved benignly and had a low incidence of CVR. Therefore, close observation is a possible protocol for managing CSdAVFs that have tolerable symptoms, no CVR, and no antegrade drainage despite aggravation or fluctuation in symptoms.
journal_name
Neuroradiologyjournal_title
Neuroradiologyauthors
Choi JH,Jo KI,Kim KH,Jeon P,Yeon JY,Kim JS,Hong SCdoi
10.1007/s00234-015-1597-2subject
Has Abstractpub_date
2015-11-01 00:00:00pages
1153-61issue
11eissn
0028-3940issn
1432-1920pii
10.1007/s00234-015-1597-2journal_volume
57pub_type
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