CLINICAL AND ANGIOGRAPHIC ASPECTS OF DURA L CAVERNOUS SINUS FISTULAS - RESULTS OF ENDOVASCULAR TREATMENT BY PARTICLES

Thirteen patients with dural fistula of the cavernous sinus were studi ed by angiography. Nine of them presented with ophthalmic symptoms (ch emosis and oculomotor disorders caused by the fistula). In one patient the lesion was discovered by chance, and 2 other patients had consult ed for a disabling tinnitus. Eight patients accepted to be treated by the endovascular route for embolization of the maxillary artery, using particles. Embolization was unilateral in 4 cases and bilateral in 4 other cases. All embolizations were followed by serial control angiogr aphy immediately performed. All subjects were seen again as out-patien ts at 3 months, and 5 of them accepted a control angiography. Three pa tients were then regarded as clinically and anatomically cured. Two pa tients with incomplete clinical and angiographic results had a second embolization which resulted in clinical and anatomical cure at a 4-mon th control examination. These 8 patients were re-examined clinically a fter one month of treatment and found to be symptomless. Only one comp lication (transient oedema of the face) was noted. Dural fistulae are lesions that are most probably acquired by alteration of the physiolog ical dural arteriovenous shunts occuring soon after venous thrombosis. Their course is capricious, and they sometimes heal spontaneously. Ho wever, the cavernous sinus location with its repercussion on the eye u sually requires treatment. This treatment is initially endovascular; s urgery and multifascicular irradiation being reserved for failures. Pa rticle embolization of maxillary arteries is a simple and efficient pr ocedure which must be used initially. If it proves insufficient, embol ization of other arterial feeders (but it is often more dangerous) or the venous route can be tried.