Abstract

OBJECTIVE: We report a case of facial nerve paralysis post-endovascular embolization of a sigmoid sinus dural arterio-venous fistula from initial presentation to current management and discuss the merits of observation versus decompression through a systematic review of relevant literature.PATIENT: 61 F with right facial palsy.INTERVENTION: Following a single intravenous dexamethasone injection with oral steroids over 2months, patient was observed with no additional treatment other than Botox chemodenervation and facial rehabilitation.OUTCOME AND RESULTS: The patient initially presented with complete right facial palsy (HB 6/6). Post-op CT imaging indicated Onyx (ev3, Irvine, California, USA) particles present at the geniculate segment of the facial nerve. Observation was chosen over surgical intervention. At the most current follow up of 8months, facial function has improved substantially (HB 2/6).CONCLUSION: Facial palsy is a serious, though rare, complication of transarterial endovascular embolization. With our case report and literature review, we highlight not only how conservative observation is the recommended treatment, but also that facial nerve recovery should be expected to reach near complete recovery, but not sooner than in 3months.

View details for DOI 10.1177/0003489420966611

View details for PubMedID 33135423