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Clinical Neurology
Original research
Newly occurring cranial nerve palsy after endovascular treatment of cavernous sinus dural arteriovenous fistulas
  1. Su Hwan Lee1,
  2. Won-Sang Cho2,
  3. Hyun-Seung Kang2,
  4. Jeong Eun Kim2,
  5. Young Dae Cho1,
  6. Dong Hyun Yoo1,
  7. Moon Hee Han1
  1. 1 Radiology, Seoul National University Hospital, Seoul, Republic of Korea
  2. 2 Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
  1. Correspondence to Professor Won-Sang Cho, Neurosurgery, Seoul National University Hospital, Seoul 110-744, Republic of Korea; nsdrcho{at}gmail.com

Abstract

Objective Cranial nerve palsy (CNP) is rarely reported after endovascular intervention for cavernous sinus dural arteriovenous fistulas (CS DAVFs). Our aim was to evaluate the treatment outcomes of CS DAVFs, and the clinical course and risk factors of newly occurring CNPs, with a review of the literature.

Methods 121 patients with 134 lesions treated in our institution were selected. They were retrospectively analyzed in terms of baseline characteristics, radiologic results, clinical outcome, and newly occurring CNPs after treatment. Angiographic and clinical follow-up data were available for 104 lesions (77.6%) and 130 lesions (97.0%), respectively.

Results The angiographic results showed partial:complete obliterations in 13:91 (87.5%) at the final follow-up. Clinical outcomes were deteriorated or no change:improved or completely recovered (3:126 (96.9%)) at the final follow-up. New CNPs occurred in 24 patients (19.8%), including the sixth CNP alone or mixed in 23 patients (95.8%). 23 cases were completely recovered or improved (21 and 2 cases, respectively), and 19 (90.4%) of 21 were completely recovered within 6 months after treatment. In the multivariate analysis, pretreatment cranial nerve symptoms (OR=0.33; 95% CI 0.14 to 0.76; P=0.010) and complete obliteration immediately after treatment (OR=0.32; 95% CI 0.12 to 0.85; P=0.021) were significant preventive factors for new CNPs. Embolization in the posterior compartments of the CS (OR=5.15; 95% CI 1.71 to 15.47; P=0.004) was a significant risk factor.

Conclusions Endovascular intervention was satisfactory in patients with CS DAVFs. The prognosis of newly occurring CNPs was favorable.

  • cavernous sinus
  • dural arteriovenous fistula
  • endovascular intervention
  • cranial nerve palsy

https://doi.org/10.1136/neurintsurg-2018-014704

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    Footnotes

    • Contributors W-SC conceived the idea for the study. SHL and W-SC collected the data and wrote the manuscript. H-SK, YDC, DHY, and MHH treated all of the patients under the same strategy and recorded all of the critical data about the procedure. W-SC, H-SK, and JEK managed all the patients during the perioperative period and recorded all of the critical data on the clinical course of cranial neuropathy. W-SC, JEK, H-SK, and MHH made a critical review of the manuscript. W-SC and institutional statisticians performed the statistical analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The study was approved by the institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.