Introduction: The clinical implication of residual shunt seen immediately after endovascular treatment (EVT) of cavernous sinus arterio-venous fistula (CS-dAVF) is not well known.
Methods: We retrospectively reviewed clinical course and changes in neuroimaging finding of 17 patients with residual shunt out of 50 patients who underwent EVT for CS-dAVF.
Results: No major retrograde shunt flow nor cortical reflux was seen in these 17 patients. Shunt flow was seen mainly in the inferior petrosal vein (IPS) in 8 patients and in both superior ophthalmic veins (SOVs) and the IPS in 9 patients. Among the 17, 3 underwent a second tVE procedure; it obliterated shunt flow. Stereotactic radio-surgery using a gamma-knife unit was performed in 4 patients. The other 10 underwent no additional procedures. The shunts eventually disappeared in all 17 patients at 1 - 42 months after the initial ETV (median 4-, mean 12.7 ± 13.3 months). Shunt related symptoms completely disappeared in 14 (82.3%) out of the 17 patients at the latest follow-up. No aggravation of symptoms was seen in the other 3 patients.
Conclusions: Considering the well manageable nature of minor residual shunt flow after the EVT, the tight packing of cavernous sinus aiming complete disappearance of shunt flow should be avoided; which may result in the aggravation of the cavernous sinus symptoms.
Patient Care: It is conducive to establish better treatment strategy for CS-dAVF
Learning Objectives: The clinical implication of residual shunt flow after endovascular treatment of CS-dAVF