Endovascular therapy for cavernous sinus dural arteriovenous fistulas: a single-center retrospective study

Objective To evaluate the clinical efficacy of endovascular therapy for cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods A single-center, retrospective cohort study was conducted involving patients with CSDAVFs who underwent endovascular therapy performed by a single neurointerventionalist at West China Hospital, Sichuan University, between January 2023 and December 2025. Data collected included demographic characteristics, presenting symptoms and neurological signs, baseline and follow-up imaging findings (including digital subtraction angiography), procedural details (e.g., access route, embolic agents, technical success), and clinical outcomes—including angiographic occlusion status, symptom resolution, procedure-related complications, and functional recovery. Results Fourteen patients were diagnosed with cavernous sinus dural arteriovenous fistulas (CSDAVFs). Twelve underwent endovascular treatment following definitive diagnosis by digital subtraction angiography (DSA); two declined intervention despite confirmed diagnosis. Thirteen presented with predominant ocular manifestations—such as proptosis, chemosis, and ophthalmoparesis—while one was diagnosed incidentally on cranial MRI performed for headache and dizziness. All 12 patients underwent the procedure successfully: seven underwent arterial-access embolization and five underwent venous-access embolization. Onyx liquid embolic agent was used as the sole embolic material in seven cases; in the remaining five cases, detachable coils were employed as adjunctive agents. Immediate post-procedural DSA demonstrated complete occlusion in nine patients and subtotal occlusion in three. Procedure-related complications occurred in five patients: visual acuity reduction ( n = 2), ipsilateral facial hypoesthesia ( n = 2), and isolated impairment of abduction and downward gaze ( n = 1). Symptomatic improvement was observed in seven patients. At 1-year clinical and imaging follow-up, all 12 treated patients remained under surveillance. Ten exhibited no recurrence; notably, one patient with initial subtotal occlusion achieved complete angiographic occlusion during follow-up. In the remaining two, residual lesions remained stable in size, symptoms improved, and no secondary intervention was required. Among the five patients with procedure-related complications, two developed persistent facial hypoesthesia after intra-arterial embolization; subjective numbness gradually improved but did not fully resolve during follow-up. Conclusion Endovascular therapy for craniospinal dural arteriovenous fistula (CSDAVFs) is associated with favorable clinical and angiographic outcomes. Although procedure-related complications occur in a subset of patients, most are transient and resolve spontaneously or improve to partial remission during follow-up. Collectively, these findings support endovascular therapy as a safe and effective treatment modality for CSDAVFs.