The data from 165 consecutive patients diagnosed as cavernous sinus dural arteriovenous fistula (CS-dAVF) from January 2005 to September 2018 were analyzed. The demographic data included approaching route, embolization times, embolization material, the sequence of embolization, number of embolization sessions, and angiographic and clinical outcomes. Inter-rater reliability of bilateral CS-dAVF diagnosis was performed using the Kappa coefficient. The factors associated with treatment outcome were analyzed using Pearson's χ2 test.
Bilateral CS-dAVF was detected in 43 patients (26%). Angiographic presentations that showed evidence of sinus thrombosis, dangerous venous drainage, and higher Satomi classification were more commonly found in bilateral CS-dAVF than in unilateral CS-dAVF. Good clinical outcome and cure from angiography were obtained in 90% and 74%, respectively. Ipsilateral inferior petrosal sinus-intercavernous sinus-contralateral CS catheterization was the major approach route of treatment. The factors associated with improved clinical outcome were transvenous approach, shunt closure, coil embolization, and sequencing the embolization (P < 0.001).
Dangerous venous drainage tends to increase in bilateral CS-dAVF. Retrograde ipsilateral inferior petrosal sinus catheterization using coil embolization and sequencing the embolization are the major concerns for treatment 1).