E-028 Delayed cranial nerve palsy after transvenous embolization of indirect carotid cavernous fistulae

Introduction Carotid cavernous fistulae (CCF) can present with diplopia secondary to cranial nerve palsy (CNP). Immediate development of post operative CNP has been described in the literature. This study discusses delayed presentation of CNP after complete obliteration of the CCF and resolution of initial CNP. Methods A retrospective analysis was carried out on patients with indirect CCF between 1987 and 2006 at 4 centers. Details of the endovascular procedures, embolic agents used, and complications were studied. Partial and complete obliteration was noted. Immediate and delayed cranial nerve palsies were assessed. Results 267 patients with symptomatic indirect CCF underwent endovascular treatment. 4 patients (1.5%) developed delayed abducens nerve (VI) palsy after complete resolution of presenting symptoms after embolization. Delayed presentation ranged between 3 months -13 months after complete resolution of initial double vision and cranial nerve palsies. Transvenous coil embolization through the inferior petrosal sinus was performed in all four affected patients. All had follow up angiography demonstrating durable closure of their CCF. In all four patients, their abducens nerve (VI) palsy remained. Conclusion Delayed CNP can develop despite complete endovascular obliteration of the CCF. Long term follow-up is needed even after complete neurological and radiological recovery is attained in the immediate perioperative period. Disclosures A. Wang: None. M. Alexander: None. P. Meyers: None.