Introduction To evaluate the efficacy of ethanol, as well as ethanol and coils, in the management of complex dural AVF.
Methods Fifteen patients (mean age 39 years; 10 females, 5 males). All patients presented with dural AVF involving the transverse sinus, sigmoid sinus and cavernous sinus. One patient suffered from high output cardiac state due to the massive size of her combined dural fistula and scalp AVM. All patients underwent MR and cerebral arteriogram evaluations. Patients underwent ethanol embolisation, coil embolisation or ethanol and coil embolisation in combination. These acquired AVF were non-traumatic.
Results All fifteen patients were endovascularly cured of their disease at a mean follow-up of five months. One patient’s therapy is on-going. In those patients who had thrombosed sigmoid sinuses and partially thrombosed transverse sinuses with critical venous drainage due to the occluded sinuses, novel endovascular approaches were utilised to reach the point of fistualisation and treat with coils and ethanol. Sacrifice of the diseased transverse and sigmoid sinus were also utilised to treat the large dural AVFs involving these segments. In the cavernous sinus only coil embolisation and nBCA embolic agents were utilised. In those patients presenting the pulsatile tinnitus, it was absent at follow-up. Headaches and all other symptoms were resolved. Except for one patient with a transient homonymous hemianopsia, no other complication occurred.
Conclusion Complex acquired dural AVF can be treated by endovascular means. With meticulous technique complications can be avoided. Long-term cures have been documented with retrograde approaches within the dural sinuses using ethanol, coils, and at times nBCA. By this venous approach complications can be vastly diminished.
Disclosures W. Yakes: None.
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