Walsh & Hoyt: Prognosis after Treatment

It is not unusual for dural CCFs to recanalize or form new abnormal vessels after transarterial embolization with particles or other material. Recurrence of ocular symptoms and signs heralds the recurrence of the fistula, and patients in whom manifestations recur require repeat angiography and consideration of further treatment. We are less concerned about incomplete closure or recurrence if we have closed the fistula transvenously using one or more detachable balloons or multiple detachable platinum coils. As with direct CCFs, symptoms and signs usually begin to improve within hours to days after successful, permanent closure of a dural CCF. Any preexisting bruit immediately disappears, and intraocular pressure immediately returns to normal. Proptosis, conjunctival chemosis, redness of the eye, and ophthalmoparesis (whether caused by orbital congestion or ocular motor nerve paresis) usually resolve completely within weeks to months, and most patients have a normal or near-normal external appearance within 6 months.