Clinical and angiographic factors related to the prognosis of cavernous sinus dural arteriovenous fistula

Endovascular occlusion of the fistula has been the most widely accepted treatment for cavernous sinus dural arteriovenous fistula (CS-dAVF). Although the CS-dAVF prognosis is generally good, physicians have noted poor recoveries, paradoxical worsening, or recurrences in some cases. In this study, we sought to identify factors that influence the prognoses of CS-dAVF patients. We enrolled 76 patients diagnosed with CS-dAVF by conventional angiography in this study and analyzed their medical records for a mean follow-up period of 20 months. We assessed the clinical and radiological factors associated with poor recovery, paradoxical worsening, and recurrence. The 76 CS-dAVF patients (25 men, 51 women, ages 24 to 77 years) underwent treatment via transvenous and/or transarterial embolization. Initially, we achieved successful occlusion in 64 patients (84.2%). Of the treated patients, 53 (69.7%) were cured, 14 (18.4%) showed significant improvement, and nine (11.8%) remained static or worsened. Poor recovery was associated with significant residual shunt after embolization and with a late-restrictive CS-dAVF type. Among the 64 initially occluded patients, paradoxical worsening was more frequent in patients who had a greater number of draining veins. Recurrence was more prevalent in younger patients. CS-dAVF can have eccentric features, such as lasting symptoms, paradoxical worsening, and recurrence after embolization. Poor recovery was associated with residual shunt and with the late-restrictive type, paradoxical worsening was associated with number of draining veins, and recurrence occurred more often in younger patients.