Abstract
Purpose: :
This study was designed to compare ophthalmological symptoms of dural fistulas (DF) and carotid-cavernous direct fistulas (CCF), before and after endovascular treatment, and to find out risk factors for ophthalmological sequellae.
Methods: :
We retrospectively studied 44 patients suffering from cavernous sinus fistulas with ophthalmologic symptoms, held in Lariboisière Hospital in Paris and Dupuytren Hospital in Limoges over 8 years. Twenty-four patients had DF, 20 had CCF. Two patients had spontaneous disappearance of the fistula, and 4 after non-invasive treatment. The remaining 40 patients underwent endovascular treatment, until complete exclusion of the fistula (33 had a single treatment, and 5 had to be retreated).
Results: :
The main pre-treatment symptoms were proptosis (n=38), episcleral venous congestion (n=31), oculomotor palsy (n=28), visual loss (n=20), glaucoma (n=17) and controlateral ocular symptoms (n=11). Thrill and murmur were more frequent in CCF (6 and 12) than in DF (0 and 5) (p<0,05). In patients with DF, the average age was greater (p<0,005) and glaucoma more frequent (p=0,005). Fourteen patients had ophthalmological sequellae, oculomotor palsies in most cases (n=8). Ophthalmological sequellae were more frequent in patients with pre-treatment visual impairement (p<0,05).
Conclusions: :
The risk of ophthalmological sequellae was higher in patients with pre-treatment visual impairement, and lower in patients with complete anatomical cure of the fistula. 68% of patients had no ophthalmological sequellae after endovascular treatment, and 93,2% after specific additional medical treatment.
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • neuro-ophthalmology: diagnosis • quality of life