Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases

Background. Transvenous embolisation is an effective option in the treatment of dural carotid-cavernous fistulas (DCCFs). This can be achieved via a number of venous routes. Method. From 1997 to 2001. 27 patients with DCCFs (15 unilateral and 12 bilateral) were treated by transvenous embolisation with Guglielmi detachable coils and fibered platinum coils. The transvenous embolisation routes included inferior petrosal sinus (IPS) alone (18 patients), IPS and inter-cavernous sinus (6 patients), IPS and clival plexus (1 patient), superior ophthalmic vein (SOV) via facial vein (1 patient) and SOV via superficial temporal vein (1 patient). One patient required further transarterial embolisation with polyvinyl alcohol particles. Findings. The follow-up period ranged from 4 to 57 months (average 26 months). Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the DCCF during the follow-up. There was no permanent procedure-related morbidity. Clinical cure was achieved in 26 patients (96) and complete angiographic obliteration was documented in 24 patients (89%). Interpretation. DCCFs can be successfully treated by transvenous embolisation via different venous routes.