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Clinical features, treatment, and outcomes of cavernous sinus dural arteriovenous fistulas: a cohort study of 141 patients

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Abstract

Purpose

The cavernous sinus (CS) region is a common region of dural arteriovenous fistula (DAVF). Over time, treatment strategies are gradually changing. In this study, we present our center's experience in managing CS-DAVF over the past 20 years.

Methods

Medical records of patients diagnosed with CS-DAVF between 2002 and 2021 were collected for analysis. Patients meeting the predefined inclusion and exclusion criteria were included. This study summarized and analyzed their clinical characteristics, CS-DAVF angioarchitecture, treatment strategies, and outcomes.

Results

A total of 141 patients (mean age 55 years, 46 males) were included in this study. Ocular/orbital symptoms were the most frequently reported initial symptoms, with 84 (59.6%) patients experiencing these symptoms first. Presentation with ocular/orbital symptoms as the first symptom was associated with thrombosis of the inferior petrosal sinus (p = 0.032). Presentation with headache/dizziness and tinnitus/intracranial murmur as the first symptom was associated with sphenoparietal sinus/superficial middle cerebral vein drainage (p = 0.011). Among the patients, 131 (92.9%) patients received endovascular treatment, with 114 (87.0%) undergoing transvenous embolization. Onyx (92.4%) and coil (74.8%) were the most used embolic materials. 17 (13.0%) of the patients who received endovascular treatment suffered intraoperative or postoperative complications, and 11 (64.7%) patients fully recovered within 6 months after discharge.

Conclusion

Ocular/orbital symptoms were the most common first symptom of CS-DAVF. The mode of venous drainage played a significant role in determining the first symptoms. Transvenous embolization using Onyx or a combination of Onyx and coils was the primary treatment modality.

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Data availability

The data that support the findings of this study were available from the corresponding author upon reasonable request.

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Acknowledgements

None.

Funding

This study was supported by National Natural Science Foundation of China. Award Number: 82101460.

Author information

Author notes

  1. Zihao Song and Yongjie Ma have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, **cheng District, Bei**g, 100053, China

    Zihao Song, Yongjie Ma, **n Su, Yuxiang Fan, Hongqi Zhang, Ming Ye & Peng Zhang

  2. China International Neuroscience Institute (China-INI), Bei**g, China

    Zihao Song, Yongjie Ma, **n Su, Yuxiang Fan, Hongqi Zhang, Ming Ye & Peng Zhang

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  1. Zihao Song
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Contributions

ZS and YM and contributed equally to this work and should be considered co-first authors. ZS, wrote the manuscript and arranged ideas. YM revised the manuscript and designed writing ideas. XS collected clinical and radiological data. YF followed up patients and did the statistics. HZ analyzed imaging data and ideas supervision. MY analyzed imaging data and ideas supervision. PZ analyzed imaging data and analyzed ideas supervision. All the authors made critical revisions of the manuscript and reviewed the final version.

Corresponding authors

Correspondence to Hongqi Zhang, Ming Ye or Peng Zhang.

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This study was approved by Ethics Committee of Xuanwu Hospital of Capital Medical University.

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Song, Z., Ma, Y., Su, X. et al. Clinical features, treatment, and outcomes of cavernous sinus dural arteriovenous fistulas: a cohort study of 141 patients. Acta Neurol Belg 124, 803–811 (2024). https://doi.org/10.1007/s13760-023-02405-9

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