Transvenous Coil Embolization of Cavernous Sinus Dural Arteriovenous Fistula on a Revised Classification

Transvenous coil embolization is an effective method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some CSDAVFs may be associated with complex angioarchitecture, leading to difficult access. In this article we report our experience with coil embolization of CSDAVFs.

Over a 5-year period, 70 patients (24 men and 46 women; mean age, 60 years) underwent coil embolization of a total of 73 CSDAVFs at our institution. We retrospectively analyzed and categorized the CSDAVFs based on a revised classification scheme as proliferative type (PT), restrictive type (RT), or late restrictive type (LRT). Outcomes of embolization in each type were evaluated.

Pial vein reflux was seen in 2 PT (10%), 10 RT (37%), and 15 LRT (60%) CSDAVFs (P = 0.005). Para-CS fistula components were found in 12 PT (57%), 1 RT (4%), and 0 LRT CSDAVFs. Mean coil length occlusion was 432 cm for PT, 275 cm for RT, and 106 cm for LRT (P < 0.001). Immediate cure was achieved in 12 PT (57%), 23 RT (85%), and 20 LRT (95%) (P = 0.001). No major periprocedural complications were associated with any CSDAVFs. The mean duration of clinical follow-up was 17 months.

Embolization outcomes may depend on the type of CSDAVF. The PT fistulas needed longer coils to achieve better angiographic outcomes. Some LRT fistulas may be difficult to access, and less coil utilization may lead to total fistula occlusion.