Transvenous embolization of dural carotid-cavernous fistulas through multiple venous routes

Objective To explore the method and strategy of transvenous embolization of dural carotid- cavernous fistulas by multiple venous routes and evaluate its clinical efficacy.Methods Twenty-seven patients with dural carotid-cavernous fistulas were treated by transvenous embolization with microcoils through the in- ferior petrosal sinus,superior ophthalmic vein and facial vein.Results Clinical cure was achieved in 23 cases and significant improvement of the symptoms in 4 cases.Twenty-two patients showed complete angiographic ob- literation immediately after the operation,and in the other 5 patients who had cavernous sinus embolization,2 presented with residual shunting drained via the pterygoid drainage,1 via the inter-cavernous sinus,and 2 via the inferior petrosal sinus.The shunting disappeared one month after manual compression of the carotid artery in these 5 patients.The common complications of embolization included headache and vomiting,and 3 patients had mild diplopia after the operation,which was relieved without interventions.No permanent procedure-related morbidity occurred in these patients,and the follow-up for 5 months to 6 years found no cases of recurrence. Conclusions Transvenous embolization via different venous routes is safe and efficient for treatment of caver- nous sinus dural arteriovenous fistula.(Shanghai Med J,2008,31:158-160)