{"title":"Endovascular Treatment of Trigeminal Cavernous Fistula: Multicenter Experience and Literature Review.","authors":"Shin-Nan Lin, Ho-Fai Wong, Chung-Wei Lee, Shih-Wei Hsu, Chung-Jung Lin, Chang-Hsien Ou","doi":"10.1093/bjr/tqaf168","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Trigeminal cavernous fistula (TCF) is rare. This study shares treatment experiences and reviews published cases.</p><p><strong>Methods: </strong>Between January 1990 and December 2024, eight consecutive TCF cases from five institutes were retrospectively enrolled, along with 38 cases identified via PubMed. Two interventional neuroradiologists independently reviewed and analyzed the cases.</p><p><strong>Results: </strong>This study enrolled 46 TCF patients, including 26 spontaneous (5 men, 21 women; age range, 22-74 years; mean age, 50.8 years) and 20 traumatic cases (11 men, 8 women, and 1 unknown gender; age range, 16-84 years; mean age, 39.7 years). PPTA aneurysms were identified in 9 spontaneous (34.6%) and 2 traumatic cases (10.0%). Five cases were treated with combined PPTA aneurysm obliteration and trapping, five with PPTA aneurysm obliteration, and one with embolization of the cavernous sinus alone; all achieved immediate occlusion without recurrence or permanent complications. Among cases without visible PPTA aneurysms, four spontaneous and five traumatic cases with type 2 PPTA underwent PPTA trapping, achieving immediate occlusion rates of 100.0% and 80.0%, respectively, and complete occlusion in all cases, with only one recurrence in a traumatic case, without permanent complication. Thirteen spontaneous and twelve traumatic TCF cases with any type PPTA without PPTA aneurysms underwent embolization of the cavernous sinus alone, achieving immediate occlusion rates of 61.5% and 75.0%, complete occlusion in all cases, and comparable recurrence (16.7% and 20.0%) and permanent complication rates (7.7% and 8.3%).</p><p><strong>Conclusion: </strong>EVT achieves high occlusion rates with low recurrence and complication rates in TCF cases.</p><p><strong>Advances in knowledge: </strong>In the treatment of TCF associated with PPTA aneurysms, PPTA aneurysm obliteration is essential and most effective. Additionally, PPTA trapping serves as an effective strategy for TCF cases with type 2 PPTA.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/bjr/tqaf168","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Trigeminal cavernous fistula (TCF) is rare. This study shares treatment experiences and reviews published cases.
Methods: Between January 1990 and December 2024, eight consecutive TCF cases from five institutes were retrospectively enrolled, along with 38 cases identified via PubMed. Two interventional neuroradiologists independently reviewed and analyzed the cases.
Results: This study enrolled 46 TCF patients, including 26 spontaneous (5 men, 21 women; age range, 22-74 years; mean age, 50.8 years) and 20 traumatic cases (11 men, 8 women, and 1 unknown gender; age range, 16-84 years; mean age, 39.7 years). PPTA aneurysms were identified in 9 spontaneous (34.6%) and 2 traumatic cases (10.0%). Five cases were treated with combined PPTA aneurysm obliteration and trapping, five with PPTA aneurysm obliteration, and one with embolization of the cavernous sinus alone; all achieved immediate occlusion without recurrence or permanent complications. Among cases without visible PPTA aneurysms, four spontaneous and five traumatic cases with type 2 PPTA underwent PPTA trapping, achieving immediate occlusion rates of 100.0% and 80.0%, respectively, and complete occlusion in all cases, with only one recurrence in a traumatic case, without permanent complication. Thirteen spontaneous and twelve traumatic TCF cases with any type PPTA without PPTA aneurysms underwent embolization of the cavernous sinus alone, achieving immediate occlusion rates of 61.5% and 75.0%, complete occlusion in all cases, and comparable recurrence (16.7% and 20.0%) and permanent complication rates (7.7% and 8.3%).
Conclusion: EVT achieves high occlusion rates with low recurrence and complication rates in TCF cases.
Advances in knowledge: In the treatment of TCF associated with PPTA aneurysms, PPTA aneurysm obliteration is essential and most effective. Additionally, PPTA trapping serves as an effective strategy for TCF cases with type 2 PPTA.
期刊介绍：
BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences.
Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of Computed Tomography "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896.
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- 2015 Impact Factor – 1.840
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- ISSN: 0007-1285
- eISSN: 1748-880X
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