Objective: Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, in even Asian countries. Clinical and radiologic outcomes of treating such fistulas through endovascular embolization are presented herein.

Materials and Methods All data were obtained from 220 consecutive patients with CSdAVF who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed, with emphasis on the technical aspects of treatment.

Results At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, four patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with single-stage transvenous embolization (TVE) in 15 patients, via bilateral IPSs (n=9) and unilateral IPS (n=6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was finally achieved in 32 lesions after TVE. Seven patients (41.2%) developed paradoxical worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery whereas the other 3 remained with deficits.

Conclusions: With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, paradoxical aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.

Disclosures: J. Lim: None. Y. Cho: None. H. Kang: None. M. Han: None.