Results of Transvenous Embolization of Cavernous Dural Arteriovenous Fistula: A Single-Center Experience with Emphasis on Complications and Management

BACKGROUND AND PURPOSE: To describe the results of transvenous embolizations of cavernous dural arteriovenous fistua (cDAVF) with an emphasis on identifying the incidence, characteristics, and management strategies associated with the complications of transvenous embolization of cDAVFs. METHODS: Fifty-six consecutive patients who were treated by transvenous embolization for cDAVFs were reviewed. The approach routes, angiographic results, complications, and clinical outcome were assessed. RESULTS: Retrograde inferior petrosal sinus (n 36), transfacial vein (n 7), transcontralateral intercavernous sinus (n 4), and direct superior ophthalmic vein (n 3) approaches were used. Angiographic results showed complete occlusion (n 29), nearly complete occlusion (n 13), and incomplete occlusion (n 14). Complications associated with the procedures were cranial nerve palsy (n 6), venous perforation (n 3), and brain stem congestion (n 2). The cranial nerve signs resolved with conservative treatment. Venous perforations were managed by coil embolizations at the site of the tear with no significant neurologic sequelae. One case of brain stem congestion resulted in hemiplegia after conservative treatment. The other case showed venous congestion as a result of rerouting of the shunted flow after venous embolization that was successfully managed by covere