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L. Boivin, R. Chapot, J.-P. Adenis, E. Houdart, P.-Y. Robert; Ophthalmological Symptoms in Carotid-Cavernous Sinus Fistulas. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6021. doi: https://doi.org/.
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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.
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).
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).
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.
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