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Pichardo-Rojas PS, Marín-Castañeda LA, De Nigris Vasconcellos F, Flores-López SI, Coria-Medrano A, de Teresa López-Zepeda P, Sánchez-Serrano CD, Torres-Chávez MC, Escobar-López JM, Choque-Ayala LC, Jowah G, Rangel-Castilla L. Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review. World Neurosurg 2024; 184:e554-e576. [PMID: 38336210 DOI: 10.1016/j.wneu.2024.01.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. METHODS We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. RESULTS The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. CONCLUSIONS IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.
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Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
| | | | - Fernando De Nigris Vasconcellos
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Shadia I Flores-López
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad en Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Estado de México, Huixquilucan de Degollado, México
| | - Adrian Coria-Medrano
- Instituto de Neurobiología, Campus Universidad Nacional Autónoma de México-Juriquilla, Querétaro, México
| | | | - Claudia D Sánchez-Serrano
- Centro Universitario de Ciencias de la Salud, Guadalajara, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Mario C Torres-Chávez
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Jesús M Escobar-López
- Escuela de Ciencias de la Salud, Universidad Del Valle de México, Ciudad de México, México
| | - Luz C Choque-Ayala
- Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Gorbachev Jowah
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
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Tozzi A, Castellucci A, Ferrulli G, Martellucci S, Malara P, Brandolini C, Armato E, Ghidini A. Low-Frequency Air-Bone Gap and Pulsatile Tinnitus Due to a Dural Arteriovenous Fistula: Considerations upon Possible Pathomechanisms and Literature Review. Audiol Res 2023; 13:833-844. [PMID: 37987331 PMCID: PMC10660785 DOI: 10.3390/audiolres13060073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Low-frequency air-bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window syndromes. Other inner disorders, including Meniere's disease (MD), perilymphatic fistula and intralabyrinthine schwannoma, might sometimes result in a similar scenario. On the other hand, PT is frequently associated with dural arteriovenous fistula (DAVF), while conductive hearing loss (CHL) is extremely rare in this clinical setting. A 47-year-old patient was referred to our center with progressive left-sided PT alongside ipsilateral fullness and hearing loss. She also experienced headache and dizziness. Otoscopy and video-oculographic examination were unremarkable. Conversely, a detailed instrumental audio-vestibular assessment revealed low-frequency CHL with normal impedance audiometry, slight left-sided caloric weakness, slightly impaired vestibular-evoked myogenic potentials on the left and normal results on the video-head impulse test, consistent with an MD-like instrumental profile. Gadolinium-enhanced brain MRI revealed an early enhancement of the left transverse sinus, consistent with a left DAVF between the left occipital artery and the transverse sinus, which was then confirmed by angiography. A trans-arterial embolization with Onyx glue was performed, resulting in a complete recession of the symptoms. Post-operatively, the low-frequency ABG disappeared, supporting the possible role of venous intracranial hypertension and abnormal pressure of inner ear fluids in the onset of symptoms and offering new insights into the pathomechanism of inner ear CHL.
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Affiliation(s)
- Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
| | - Enrico Armato
- Faculty of Medicine, University of Lorraine, 54000 Vandoeuvre-lès-Nancy, France;
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
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Tsukada T, Izumi T, Nishihori M, Araki Y, Uda K, Yokoyama K, Saito R. Transarterial embolization and transvenous embolization for transverse-sigmoid sinus dural arteriovenous fistulas with cortical venous reflux: A comparative study. Interv Neuroradiol 2023:15910199231195135. [PMID: 37574796 DOI: 10.1177/15910199231195135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) carry a high risk for neurological sequelae or death. Recently, transverse-sigmoid sinus DAVFs were shown as good indications for transarterial embolization (TAE) with ONYX. Here, we compared the effectiveness and safety of conventional transvenous embolization (TVE) with those of TAE with ONYX for transverse-sigmoid sinus DAVFs with CVR. METHODS Sixty-one patients with transverse-sigmoid sinus DAVFs were treated from April 2013 to May 2020. Among them, 37 patients with CVR were included. Transarterial embolization and TVE were compared in terms of complete occlusion and residual CVR immediately after treatment, complications with worsening modified Rankin Scale (mRS) ≥ 1, amount of contrast media used during treatment, radiation exposure, and surgical procedure time. RESULTS Ten patients were treated with 10 TAEs using ONYX and 27 patients with 29 TVEs. Transarterial embolization and TVE showed no differences in the overall complete occlusion rate (80% [8/10 patients] vs. 80% [23/27], respectively), whereas the residual rate of existing CVR was 10% (1/10 patient) vs. 3.4% (1/27) in the TAE and TVE groups, respectively. No complications with worsening mRS ≥1 occurred in either group. Among the parameters of amount of contrast media, radiation dose, and operative time, only radiation dose in the TAE group was lower than that in the TVE group (median: 2239 mGy vs. 3268 mGy, respectively; p = 0.07). CONCLUSION For transverse-sigmoid sinus DAVFs with CVR, TAE treatment reduced radiation exposure. However, both TAE and TVE achieved high complete occlusion rates and low complication rates.
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Affiliation(s)
- Tetsuya Tsukada
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Withers J, Regenhardt RW, Dmytriw AA, Vranic JE, Marciano R, Stapleton CJ, Patel AB. Direct Burr Hole Access for Transverse-Sigmoid Junction DAVF Embolization: A Case Report. Brain Sci 2023; 13:871. [PMID: 37371351 DOI: 10.3390/brainsci13060871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid-jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse-sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results.
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Affiliation(s)
- James Withers
- College of Osteopathic Medicine, University of New England, Biddeford, ME 04005, USA
| | - Robert W Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Adam A Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Justin E Vranic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
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Mundhe VM, Singh RS, Singh N, Karapurkar A, Deshmukh N, Reddy J. Our Experience of Eight Patients with Dural Arteriovenous Fistula's at Foramen Magnum with Respect to Presentation, Angioarchitecture, and Endovascular Treatment Outcomes. Asian J Neurosurg 2023; 18:17-24. [PMID: 37056884 PMCID: PMC10089738 DOI: 10.1055/s-0042-1751004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background Dural arteriovenous fistulas (DAVFs) around foramen magnum (FM) with peri medullary venous drainage, are uncommon and have wide spectrum of presentation. Literature about this lesion is sparse. We intent to analyze and report our experience with these cases with respect to presentation, evaluation, and endovascular treatment outcomes.
Materials and Methods All the eight patients who were diagnosed with DAVFs at FM and treated with transarterial embolization using ethylene viny alcohol were included in this study. Clinical record sheets, radiological, and angiographic data of these patients were retrieved from our departmental database.
Results Duration of symptoms ranged from 1 day to 3 years. Presentation with progressive ascending sensory symptoms and weakness (N = 4), acute headache (N = 2) acute quadriplegia (N = 1), and right ear bruit (N = 1) was seen. Exclusive feeders from occipital artery (OA) and vertebral artery (VA) were seen in two and four patients, respectively. Dual feeders from a combination of ascending pharyngeal artery and VA; from a combination of OA and VA were seen in one patient each. The exclusive venous drainage to spinal peri medullary veins (N = 3), brain stem peri medullary veins (N = 1), and both combined (N = 4). Two patients had a draining vein aneurysm. Complete obliteration of fistula was achieved in all patients. Complete resolution of symptoms was seen in six patients; two patients had significant improvement.
Conclusion The clinical presentation of dural AVF at foramen magnum is wide ranging and these lesions can be treated effectively and safely by transarterial embolization. Duration of symptoms strongly influences the final patient outcome.
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Bhatia KD, Lee H, Kortman H, Klostranec J, Guest W, Wälchli T, Radovanovic I, Krings T, Pereira VM. Endovascular Management of Intracranial Dural AVFs: Transvenous Approach. AJNR Am J Neuroradiol 2022; 43:510-516. [PMID: 34649915 DOI: 10.3174/ajnr.a7300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/09/2021] [Indexed: 11/07/2022]
Abstract
In this third review article on the endovascular management of intracranial dural AVFs, we discuss transvenous embolization approaches. Transvenous embolization is increasingly popular and now the first-line approach for ventral dural AVFs involving the cavernous sinus and hypoglossal canal. In addition, transvenous embolization is increasingly used in lateral epidural dural AVFs in high-risk locations such as the petrous and ethmoid regions. The advantage of transvenous embolization in these locations is the ability to retrogradely embolize the draining vein and fistula while reducing the risk of ischemic cranial neuropathy or brain parenchymal infarction commonly feared from a transarterial approach. By means of coils ± ethylene-vinyl alcohol copolymer, transvenous embolization can achieve angiographic cure rates of 80%-90% in ventral locations. Potential complications include transient cranial neuropathy, neurologic deterioration due to venous outflow obstruction, and perforation while navigating pial veins. Transvenous embolization should be considered when dural AVFs arise in proximity to the vasa nervosum or extracranial-intracranial anastomoses.
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Affiliation(s)
- K D Bhatia
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Medical Imaging (K.D.B.), Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Division of Paediatrics (K.D.B.), Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia
- Division of Paediatrics (K.D.B.), Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Division of Medical Imaging (K.D.B.), Faculty of Medicine, Macquarie University, Macquarie Park, New South Wales, Australia
| | - H Lee
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Department of Neurosurgery (H.L.), Stanford University School of Medicine, Stanford, California
| | - H Kortman
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neuroradiology (H.K.), Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands
| | - J Klostranec
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Interventional Neuroradiology (J.K.), McGill University Health Centre, Montreal, Quebec, Canada
| | - W Guest
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Interventional Neuroradiology (W.G., V.M.P.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - T Wälchli
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - I Radovanovic
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - T Krings
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - V M Pereira
- From the Division of Neuroradiology (K.D.B., H.L., H.K., J.K., W.G., T.K., V.M.P.)
- Division of Neurosurgery (T.W., I.R., T.K., V.M.P.), Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Interventional Neuroradiology (W.G., V.M.P.), St. Michael's Hospital, Toronto, Ontario, Canada
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Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience. Acta Neurochir (Wien) 2022; 164:151-161. [PMID: 34486069 PMCID: PMC8761147 DOI: 10.1007/s00701-021-04950-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/05/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. We hypothesize that there may be subtypes of dAVFs responding better to a specific treatment modality in terms of successful obliteration and cessation of symptoms and/or risks. METHODS All dAVFs treated during 2011-2018 at our hospital were analyzed retrospectively. Presenting symptoms, radiological variables, treatment modality, complications, and residual symptoms were related to dAVF type using the original Djindjian classification. RESULTS We treated 112 dAVFs in 107 patients (71, 66% males). They presented with hemorrhage (n = 23; 21%), non-hemorrhagic symptoms (n = 75; 70%), or were discovered incidentally (n = 9; 8%). There were 25 (22%) type I, 29 (26%) type II, 26 (23%) type III, and 32 (29%) type IV fistulas. EVT was the primary treatment modality in 72/112 (64%) dAVFs whereas 40/112 (36%) underwent primary surgery with angiographic obliteration rates of 60% and 90%, respectively. Using a secondary treatment modality in 23 dAVFs, we obtained a final obliteration rate of 93%, including all type III/IV and 26/27 (96%) type II dAVFs. Except for headache, residual symptoms were rare and minor. Permanent neurological complications consisted of five cranial nerve deficits. CONCLUSIONS We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk.
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Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: Radiosurgery as an Effective Alternative Treatment. World Neurosurg 2021; 158:e922-e928. [PMID: 34861447 DOI: 10.1016/j.wneu.2021.11.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the clinical and radiological outcome of Gamma Knife radiosurgery (GKS) in treatment of intracranial dural arteriovenous fistula (DAVF) with cortical venous drainage (CVD) and compare it with the outcome of endovascular therapy. METHODS Patients who underwent GKS or endovascular therapy for intracranial DAVF with CVD over 10 years (January 2007 to December 2016) at the All India Institute of Medical Sciences, New Delhi, were included. Demographics, clinical presentation, imaging details, and follow-up clinical status were reviewed retrospectively. Clinical follow-up was conducted once every 6 months. Radiological follow-up using digital subtraction angiography was performed at a mean 24 months after intervention. Patients with clinical follow-up of <1 year were excluded from the study. RESULTS The study included 35 patients (26 in embolization group and 9 in GKS group) who had intracranial DAVF with CVD were included in the study. Clinical improvement was seen in 77.78% of the patients who received GKS and 57.7% of the patients who underwent embolization (P = 0.431). Complete obliteration of DAVF was seen in 55.56% of the patients in the GKS group and 57.7% of the patients in the embolization group (P = 1). GKS was at least as effective as embolization in terms of clinical and radiological outcome in treatment of intracranial DAVF with CVD. CONCLUSIONS Contrary to popular perception, GKS should be considered as an effective first-line treatment alternative of intracranial DAVF with CVD.
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Lekovic GP, Barnard ZR, Master A, Mehta GU, Maya MM, Wilkinson EP. Role of cerebral digital subtraction angiography in the evaluation of pulse synchronous tinnitus. J Otol 2021; 16:225-230. [PMID: 34548868 PMCID: PMC8438631 DOI: 10.1016/j.joto.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to evaluate the value of digital subtraction angiography (DSA) in the diagnostic evaluation of a highly selected patient population presenting with pulse-synchronous tinnitus (PST). Methods We retrospectively reviewed the charts of all patients referred for evaluation of possible vascular etiology of pulsatile tinnitus. Patients were evaluated with regards to presenting signs, comorbidities, non-invasive imaging results, angiographic findings and outcomes. Results Fifteen patients underwent cerebral DSA. Dural arteriovenous fistula (dAVF) was identified in six patients, and five patients had other significant vascular pathology identified on DSA. Seven patients with ‘negative’ non-invasive imaging were found to have significant pathology on DSA. Conclusions Catheter angiography may have a significant yield in appropriately selected patients presenting with pulse synchronous tinnitus.
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Affiliation(s)
- Gregory P Lekovic
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Zachary R Barnard
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States.,Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Adam Master
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - M Marcel Maya
- Department of Imaging, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States
| | - Eric P Wilkinson
- Division of Neurotology, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
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Duvvuri M, Caton MT, Narsinh K, Amans MR. Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas. Neuroradiol J 2021; 35:412-417. [PMID: 34490800 DOI: 10.1177/19714009211042898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.
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Affiliation(s)
- Madhavi Duvvuri
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Michael T Caton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Kazim Narsinh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
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Hisaeda E, Shimada H, Ogata T, Fukuda K, Higashi T, Inoue T. Detection and Differentiation of Dural Arteriovenous Fistulas in the Transverse Sinus/Sigmoid Sinus and Cavernous Sinus Using Carotid Ultrasound: Importance of Evaluation of the Occipital Artery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:683-687. [PMID: 32833229 DOI: 10.1002/jum.15438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Dural arteriovenous fistula (DAVFs) in the transverse sinus (TS)/sigmoid sinus (SS) and cavernous sinus (CS) are observed frequently in the clinic. This study aimed to detect DAVFs with ultrasound and compare carotid ultrasound findings between these conditions. METHODS We retrospectively reviewed 26 patients with either a TS/SS DAVF or a CS DAVF who were admitted to our hospital for evaluation of DAVFs from 2014 to 2018. The shunt site decision was made by neuroendovascular experts, whereas carotid ultrasound examinations were performed by ultrasound specialists. The flow velocity of the ipsilateral external carotid artery was reviewed in all 26 patients, whereas that of the occipital artery (OA) was examined in 20 patients. Blood flow velocities were compared between the TS/SS DAVF and CS DAVF groups. RESULTS The study included 18 patients with a TS/SS DAVF (11 women and 7 men; mean age ± SD, 65.3 ± 18.6 years) and 8 patients with a CS DAVF (7 women and 1 man; mean age, 70.4 ± 9.3 years). Evaluations of feeder arteries on cerebral angiography showed that all patients had dural branches from the internal carotid and middle meningeal arteries as feeders of CS DAVFs, whereas the OA was the major feeder source of all TS/SS DAVF cases. The end-diastolic velocity (EDV) of the external carotid artery was significantly higher in patients with a TS/SS DAVF compared with those with a CS DAVF (P = .004). The EDV of the OA was significantly elevated in TS/SS DAVF cases compared with CS DAVF cases (P < .001). CONCLUSIONS Duplex ultrasound parameters are significantly different between patients with TS/SS and CS DAVFs. An increased EDV of the OA can predict the presence of a TS/SS DAVF.
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Affiliation(s)
- Emiko Hisaeda
- Clinical Laboratory, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hirofumi Shimada
- Clinical Laboratory, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyasu Ogata
- Departments of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Fukuda
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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12
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Li Y, Chen SH, Guniganti R, Kansagra AP, Piccirillo JF, Chen CJ, Buell T, Sheehan JP, Ding D, Lanzino G, Brinjikji W, Kim LJ, Levitt MR, Abecassis IJ, Bulters DO, Durnford A, Fox WC, Polifka AJ, Gross BA, Sur S, McCarthy DJ, Yavagal DR, Peterson EC, Hayakawa M, Derdeyn C, Samaniego EA, Amin-Hanjani S, Alaraj A, Kwasnicki A, Charbel FT, van Dijk JMC, Potgieser AR, Satomi J, Tada Y, Abla A, Phelps R, Du R, Lai PMR, Zipfel GJ, Starke RM. Onyx embolization for dural arteriovenous fistulas: a multi-institutional study. J Neurointerv Surg 2021; 14:neurintsurg-2020-017109. [PMID: 33632883 DOI: 10.1136/neurintsurg-2020-017109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance. OBJECTIVE To carry out a multicenter study to determine the predictors of complications, obliteration, and functional outcomes associated with primary Onyx embolization of DAVFs. METHODS From the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database, we identified patients who were treated for DAVF with Onyx-only embolization as the primary treatment between 2000 and 2013. Obliteration rate after initial embolization was determined based on the final angiographic run. Factors predictive of complete obliteration, complications, and functional independence were evaluated with multivariate logistic regression models. RESULTS A total 146 patients with DAVFs were primarily embolized with Onyx. Mean follow-up was 29 months (range 0-129 months). Complete obliteration was achieved in 80 (55%) patients after initial embolization. Major cerebral complications occurred in six patients (4.1%). At last follow-up, 84% patients were functionally independent. Presence of flow symptoms, age over 65, presence of an occipital artery feeder, and preprocedural home anticoagulation use were predictive of non-obliteration. The transverse-sigmoid sinus junction location was associated with fewer complications, whereas the tentorial location was predictive of poor functional outcomes. CONCLUSIONS In this multicenter study, we report satisfactory performance of Onyx as a primary DAVF embolic agent. The tentorium remains a more challenging location for DAVF embolization, whereas DAVFs located at the transverse-sigmoid sinus junction are associated with fewer complications.
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Affiliation(s)
- Yangchun Li
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Ridhima Guniganti
- Department of Neurological Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Akash P Kansagra
- Department of Neurological Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Jay F Piccirillo
- Department of Neurological Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Thomas Buell
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Andrew Durnford
- Department of Neurosurgery, University of Southampton, Southampton, Hampshire, UK
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Samir Sur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David J McCarthy
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Minako Hayakawa
- Division of Neurointerventional Surgery, Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Colin Derdeyn
- Department of Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edgar A Samaniego
- Department of Neurology, Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amanda Kwasnicki
- Department of Neurosurgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - J Marc C van Dijk
- Department of Neurosurgery, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
| | - Adriaan Re Potgieser
- Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands
| | - Junichiro Satomi
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Adib Abla
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Ryan Phelps
- Department of Neurosurgery, UCSF, San Francisco, California, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University, St Louis, Missouri, USA.,Department of Neurological Surgery, Washington University, St Louis, Missouri, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA .,Department of Radiology, University of Miami School of Medicine, Miami, Florida, USA
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Simple Things Are Not Simple: Pulsatile Tinnitus due to Tortuous Occipital Artery. Ann Vasc Surg 2020; 72:664.e11-664.e13. [PMID: 33227477 DOI: 10.1016/j.avsg.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/30/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulsatile tinnitus is often a chronic and debilitating condition and normally has a vascular origin. We describe a case of pulsatile tinnitus due to an aberrant branch of the external carotid artery (ECA), which has not been reported previously. METHOD A 67-year-old female with chronic unilateral pulsatile tinnitus, which could be controlled completely with direct pressure on a small tortuous superficial branch behind her left ear. This was confirmed with doppler to be an unusually tortuous occipital branch of the ECA. Under local anesthesia, this vessel was identified with intraoperative doppler and ligated. RESULT Complete resolution of tinnitus immediately, with consistent results 3 months postoperatively. CONCLUSIONS Pulsatile tinnitus due to aberrances in the occipital ECA branch is rare, and in this case, was successfully treated with minor surgery.
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Maus V, Drescher F, Goertz L, Weber A, Weber W, Fischer S. Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience. Cerebrovasc Dis Extra 2020; 10:84-93. [PMID: 32846415 PMCID: PMC7548948 DOI: 10.1159/000509455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.
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Affiliation(s)
- Volker Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany,
| | - Finn Drescher
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Lukas Goertz
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Anushe Weber
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Werner Weber
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Sebastian Fischer
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
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15
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Hiramatsu M, Sugiu K, Hishikawa T, Nishihiro S, Kidani N, Takahashi Y, Murai S, Date I, Kuwayama N, Satow T, Iihara K, Sakai N. Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3). J Neurosurg 2020; 133:166-173. [PMID: 31252394 DOI: 10.3171/2019.4.jns183458] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Embolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization. METHODS Patient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization. RESULTS Transarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non-sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications. CONCLUSIONS Complication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.
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Affiliation(s)
- Masafumi Hiramatsu
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Kenji Sugiu
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Tomohito Hishikawa
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Shingo Nishihiro
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Naoya Kidani
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Yu Takahashi
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Satoshi Murai
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Isao Date
- 1Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Naoya Kuwayama
- 2Division of Neuroendovascular Therapy, Department of Neurosurgery, University of Toyama, Toyama
| | - Tetsu Satow
- 3Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Koji Iihara
- 4Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka; and
| | - Nobuyuki Sakai
- 5Department of Neurological Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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16
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Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol 2019; 5:50-58. [PMID: 32411408 PMCID: PMC7213517 DOI: 10.1136/svn-2019-000269] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/23/2019] [Accepted: 11/11/2019] [Indexed: 11/21/2022] Open
Abstract
Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.
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Affiliation(s)
- Humain Baharvahdat
- Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Yinn Cher Ooi
- Neurointerventional Radiology, UCLA, Los Angeles, California, USA
| | - Wi Jin Kim
- Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Ashkan Mowla
- Neurointerventional Radiology, UCLA, Los Angeles, California, USA
| | | | - Geoffrey P Colby
- Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
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17
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Abstract
Headache is a milestone in cerebrovascular disorders; indeed, it may represent the only symptom at onset or predominates over the other neurological features. Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics as it may resemble a migraine attack, tension-type headache, or cluster headache; pain localization is also misleading along with drug (analgesic) response. However, in this review, we have analyzed and described the most common patterns of headache for different vascular disorders: it is known that headache due to subarachnoid aneurysmal hemorrhage presents peculiar characteristics (thunderclap, acute presentation, and high intensity), whereas in cerebral vasoconstriction syndrome, the short duration and the relapsing-remitting course of the thunderclap headache are key points for the diagnosis; in cervicocerebral artery, dissection pain is most commonly ipsilateral to the dissected vessel and is mainly perceived in the temporal area in case of carotid artery dissection and in the occipital area in case of vertebral artery dissection; in cerebral venous thrombosis, pain is often acute or subacute and severe; unfortunately, it may resemble a typical migraine attack or a tension-type episode; by the contrary, in primary angiitis of the central nervous system, pain is always subacute or chronic with mild-to-moderate intensity; finally, in brain arteriovenous shunts such as malformation or fistula, pain is more frequently a clue for disease complication such as hemorrhage from the malformation or thrombosis of the draining vein.
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Affiliation(s)
- Susanna Diamanti
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neuroscience, Neurology and Stroke Unit, ASST GOM Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
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18
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Saini J, Beniwal M, Somanna S, Deepesh A, N Rao KVL, Vazhayil V, Srinivas D. Spontaneous Closure of Dural Arteriovenous Fistula; A Visual Specter. Neurol India 2019; 67:1376-1379. [DOI: 10.4103/0028-3886.271248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Xu K, Yang X, Li C, Yu J. Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review. Int J Med Sci 2018; 15:1600-1610. [PMID: 30588182 PMCID: PMC6299407 DOI: 10.7150/ijms.27683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/14/2018] [Indexed: 12/27/2022] Open
Abstract
Most intracranial dural arteriovenous fistulae (DAVFs) involve the transverse-sigmoid sinus (TSS), and various types of endovascular treatment (EVT) have been involved in managing TSS DAVFs. A current, comprehensive review of the EVT of TSS DAVFs is lacking. This study used the PubMed database to perform a literature review on TSS DAVFs to increase the current understanding of this condition. For high-grade TSS DAVFs such as Borden type 3, the goal of EVT is curative treatment. However, for low-grade TSS DAVFs such as Borden type 1 and some Borden type 2 TSS DAVFs, symptom relief or elimination of cortical reflux may be sufficient. Currently, EVT has become the first-line treatment for TSS DAVFs, including transarterial embolization (TAE), transvenous embolization (TVE) or both. TAE alone and TSS balloon-assisted TAE are also commonly used. However, TVE for TSS DAVFs is recognized as the most effective treatment, including coil direct packing TSS, Onyx® (ethylene vinyl alcohol copolymer) TVE, and balloon-assisted Onyx® TVE, which are commonly applied. In addition, TSS reconstructive treatment can be an effective procedure to treat TSS DAVFs. EVT is accompanied with complications, including technique- and treatment-related complications. Although complications may occur, TSS DAVFs have an acceptable prognosis after EVT.
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Affiliation(s)
- Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xue Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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20
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Xu F, Gu J, Ni W, Xu Q, Gu Y, Leng B. Endovascular Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Fistulas: A Single-Center Experience with Long-Term Follow-Up. World Neurosurg 2018; 121:e441-e448. [PMID: 30267946 DOI: 10.1016/j.wneu.2018.09.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TSDAVFs) remains challenging because of their complex anatomic factors. The aim of our study was to evaluate the long-term efficacy and safety of endovascular treatment of TSDAVFs. METHODS From January 2008 to December 2014, 44 patients with TSDAVFs were treated endovascularly at our institution. The clinical and angiographic data were retrospectively collected, and the occlusion rate, complications, and clinical outcomes were analyzed. RESULTS Overall, 44 patients (26 males and 18 females) were identified, with a mean age of 47 years (range, 13-68 years). Of the 44 patients, 5 presented with Cognard type I fistula, 12 with type IIa, 6 with type IIb, 13 with type IIa+IIb, 2 with type III, and 6 with type IV. Complete (n = 29) or near-complete (n = 7) occlusion of the fistula was achieved in 36 patients (82%). Two patients experienced a transient neurological deficit (cranial nerve VII). In 31 patients with angiographic follow-up (range, 2-40 months) data available, the occlusion remained in 25, 2 previously minimal residual fistulas were completely occluded, 3 residual fistulas were unchanged, and 1 fistula recurred. Two patients with cortical venous reflux who had received incomplete treatment died of intracranial hemorrhage during the follow-up period. Of the 37 patients with clinical follow-up (mean, 33.6 months) data available, clinical cure was achieved in 29, residual symptoms remained unchanged in 7, and symptoms had deteriorated in 1. CONCLUSIONS Favorable and durable outcomes were achieved with endovascular treatment of TSDAVFs. TSDAVFs with cortical venous reflux carry a high risk of hemorrhage and require curative treatment.
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Affiliation(s)
- Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China; Department of Neurosurgery, Kashgar Prefecture Second People's Hospital, Kashgar, China
| | - Jianjun Gu
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Qiang Xu
- Department of Radiology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.
| | - Bing Leng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
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21
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Bhogal P, AlMatter M, Hellstern V, Bäzner H, Ganslandt O, Henkes H, Aguilar Pérez M. High-Grade Dural Arteriovenous Fistulas : Use of Kaneka ED Coils with the Marathon Microcatheter for Transvenous Coil Embolization. Clin Neuroradiol 2018; 29:653-660. [PMID: 30167712 DOI: 10.1007/s00062-018-0724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVF) are commonly encountered lesions that can be treated both transvenously, transarterially or using a combined approach. OBJECTIVE Transvenous coil embolization of DAVF is a recognized treatment option but can be challenging. In this context this article presents clinical experience using the Kaneka ED10 ExtraSoft coils in combination with the Marathon microcatheter to treat high grade DAVF. The physical properties of these coils and the microcatheter were also determined. MATERIAL AND METHODS All patients with high grade DAVF treated with the Marathon and the Kaneka ED COIL ∞10 ExtraSoft coils were retrospectively identified. The clinical presentation, location, grade of the lesion, clinical and radiological follow-up data were recorded. Bench side studies were performed to determine the physical properties of the Marathon catheter in comparison to the SL10 and Headway Duo as well the maximum width of the Kaneka pusher wire in comparison to Hypersoft, Target and Axium Prime coils. RESULTS A total of 8 patients with 9 DAVF with 3 Cognard 3 and 6 Cognard 4 lesions were identified. All the DAVF's were occluded either at the end of the procedure or on follow-up imaging. On bench side tests the Marathon microcatheter had the most flexible distal tip and distal shaft in comparison to the SL10 and Headway Duo. The proximal shaft of the Marathon was stiffer than the SL10. The Kaneka ED COIL ∞10 ExtraSoft had the smallest distal width and were the only coils tested that could be deployed through a Marathon microcatheter. CONCLUSION The combination of the Marathon microcatheter and Kaneka ED COIL ∞10 ExtraSoft is useful for the treatment of high grade DAVF.
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Affiliation(s)
- P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany. .,Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.
| | - M AlMatter
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - V Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Aguilar Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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22
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Miller TR, Giacon L, Kole MJ, Chen R, Jindal G, Gandhi D. Onyx embolization with the Apollo detachable tip microcatheter: A single-center experience. Interv Neuroradiol 2018; 24:339-344. [PMID: 29482458 DOI: 10.1177/1591019918758494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The Apollo Onyx Delivery Microcatheter (Ev3, Irvine, CA) is a detachable-tip microcatheter that was developed to reduce the risk of microcatheter entrapment during ethylene-vinyl alcohol copolymer (Onyx) embolizations. We report our experience with the microcatheter in a variety of neurointerventional procedures. Methods We retrospectively reviewed all Onyx embolizations performed in the head, neck, and spine using the Apollo Onyx Delivery Microcatheter from its introduction at our institution in July 2014 to August 2016. Information regarding patient diagnoses, procedural details, as well as clinical outcomes were obtained from the electronic medical record, procedure reports, and relevant angiographic imaging. Results A total of 58 arterial pedicle Onyx embolizations were performed in 37 patients. There were no cases of microcatheter entrapment, early/inadvertent tip detachment, or vessel injury upon removal of the device. There were two instances (3.5%) of leakage of Onyx from the microcatheter detachment site during embolization, which did not result in adverse sequelae. Clinical outcomes were excellent, with nearly all embolizations achieving the intended goal. In multivariate analysis, length of Onyx reflux along the microcatheter tip and utilization of a higher viscosity agent, Onyx 34, were significantly associated with tip detachment. Conclusion The use of the Apollo Microcatheter is both safe and effective during neurointerventional embolizations using Onyx. Leakage of liquid embolic agent from the detachment site is an infrequent technical complication that may be encountered with the device.
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Affiliation(s)
- Timothy R Miller
- 1 Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Luciano Giacon
- 1 Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Matthew J Kole
- 2 Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rong Chen
- 1 Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Gaurav Jindal
- 1 Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Dheeraj Gandhi
- 1 Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD, USA
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23
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Amuluru K, Al-Mufti F, Romero C. Isolated intraventricular hemorrhage secondary to dural arteriovenous fistula. J Neurointerv Surg 2018; 10:e7. [PMID: 29459368 DOI: 10.1136/neurintsurg-2017-013643.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/03/2022]
Abstract
Isolated intraventricular hemorrhage due to dural arteriovenous fistula (dAVF) is extremely rare and has been reported only a few times in the literature. The pathophysiological cause of isolated intraventricular hemorrhage in these cases was hypothetically attributed to retrograde venous flow into subependymal vessels, although none of these cases demonstrated radiographic evidence of such reflux. We present the first case of a dAVF with radiographic evidence of severe cortical venous reflux into the subependymal venous network causing isolated intraventricular hemorrhage, thus lending proof for the underlying pathophysiology. Furthermore, ours is the first case of dAVF with isolated intraventricular hemorrhage that was successfully treated using multimodality transvenous and transarterial embolization techniques. In cases of high-grade dAVF, multimodality treatment may offer the greatest chance for success, and should be strongly considered for management.
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Affiliation(s)
- Krishna Amuluru
- Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA
| | - Fawaz Al-Mufti
- Neurology - Division of Neuroendovascular Surgery and Neurocritical Care, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, USA
| | - Charles Romero
- Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA
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24
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Amuluru K, Al-Mufti F, Romero C. Isolated intraventricular hemorrhage secondary to dural arteriovenous fistula. BMJ Case Rep 2018; 2018:bcr-2017-013643. [PMID: 29437717 DOI: 10.1136/bcr-2017-013643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated intraventricular hemorrhage due to dural arteriovenous fistula (dAVF) is extremely rare and has been reported only a few times in the literature. The pathophysiological cause of isolated intraventricular hemorrhage in these cases was hypothetically attributed to retrograde venous flow into subependymal vessels, although none of these cases demonstrated radiographic evidence of such reflux. We present the first case of a dAVF with radiographic evidence of severe cortical venous reflux into the subependymal venous network causing isolated intraventricular hemorrhage, thus lending proof for the underlying pathophysiology. Furthermore, ours is the first case of dAVF with isolated intraventricular hemorrhage that was successfully treated using multimodality transvenous and transarterial embolization techniques. In cases of high-grade dAVF, multimodality treatment may offer the greatest chance for success, and should be strongly considered for management.
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Affiliation(s)
- Krishna Amuluru
- Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA
| | - Fawaz Al-Mufti
- Neurology - Division of Neuroendovascular Surgery and Neurocritical Care, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, USA
| | - Charles Romero
- Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA
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25
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Distally Enlarged Feeding Artery Phenomenon in Intracranial Dural Arteriovenous Fistula: Alternative Access Route to Transarterial Intravenous Embolization. World Neurosurg 2017; 108:447-452. [DOI: 10.1016/j.wneu.2017.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022]
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26
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Kerolus MG, Chung J, Munich SA, Matsuda Y, Okada H, Lopes DK. An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus. J Neurosurg 2017; 129:922-927. [PMID: 29148903 DOI: 10.3171/2017.5.jns17287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transvenous embolization is an effective method for treating dural arteriovenous fistulas (DAVFs) of the transverse-sigmoid sinus (TSS). However, in cases of complicated DAVFs, it is difficult to preserve the patency of the dural sinus. The authors describe the technical details of a new reconstructive technique using transvenous balloon-assisted Onyx embolization as another treatment option in a patient with an extensive and complex DAVF of the left TSS. A microcatheter and compliant balloon catheter were navigated into the left internal jugular vein and placed at the distal end of the DAVF in the transverse sinus. The microcatheter was placed between the vessel wall of the TSS and the balloon. After the balloon was fully inflated, Onyx-18 was injected at the periphery of the balloon in a slow, controlled, progressive, stepwise manner; the balloon and microcatheter were simultaneously withdrawn toward the sigmoid sinus, with Onyx encompassing the entirety of the complex DAVF. The Onyx refluxed into multiple arterial feeders in a distal-to-proximal step-by-step manner, ultimately resulting in an Onyx tunnel. The final angiography study revealed complete obliteration of the DAVF and patency of the TSS. The Onyx tunnel, or reconstructive transvenous balloon-assisted Onyx embolization technique, may be an effective treatment option for large, complex DAVFs of the TSS. This technique may provide another option to facilitate the complete obliteration of the DAVF while preserving the functional sinus.
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Affiliation(s)
- Mena G Kerolus
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Joonho Chung
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.,3Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Stephen A Munich
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Yoshikazu Matsuda
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.,4Department of Neurosurgery, Wakayama Medical University; and
| | - Hideo Okada
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.,5Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan
| | - Demetrius K Lopes
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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27
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Hu YS, Lin CJ, Wu HM, Guo WY, Luo CB, Wu CC, Chung WY, Liu KD, Yang HC, Lee CC. Lateral Sinus Dural Arteriovenous Fistulas: Sinovenous Outflow Restriction Outweighs Cortical Venous Reflux as a Parameter Associated with Hemorrhage. Radiology 2017; 285:528-535. [DOI: 10.1148/radiol.2017162594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yong-Sin Hu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chung-Jung Lin
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Hsiu-Mei Wu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Wan-Yuo Guo
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chao-Bao Luo
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chih-Chun Wu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Wen-Yuh Chung
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Kang-Du Liu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Huai-Che Yang
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Cheng-Chia Lee
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
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Early microsurgery in a paradigm of “intervention first” for skull base Cognard grade IV dural arteriovenous fistulas. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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29
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Griauzde J, Gemmete JJ, Pandey AS, Chaudhary N. Endovascular Treatment of Noncavernous Dural Arteriovenous Fistulas: Analysis of Outcomes with and without Ethylene Vinyl Alcohol. J Stroke Cerebrovasc Dis 2017; 26:1209-1215. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022] Open
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30
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Lee SH, Suh DC. Cortical versus Pial Venous Drainage in Dural Arteriovenous Fistula. Neurointervention 2017; 12:54-56. [PMID: 28316871 PMCID: PMC5355463 DOI: 10.5469/neuroint.2017.12.1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sang Hun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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31
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Mulholland CB, Kalani MYS, Albuquerque FC. Endovascular management of intracranial dural arteriovenous fistulas. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:117-123. [PMID: 28552133 DOI: 10.1016/b978-0-444-63640-9.00011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dural arteriovenous fistulas are a heterogeneous group of lesions that comprise 10-15% of intracranial vascular malformations. The treatment strategy is devised after careful consideration of the arterial supply, venous drainage, clinical presentation, and risk of progression, hemorrhage, or neurologic decline. With recent advancements in endovascular technology, the majority of dural arteriovenous fistulas can be treated with either transarterial or transvenous embolization. Those that cannot be fully treated by endovascular means are approached with either adjuvant surgery or radiotherapy.
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Affiliation(s)
- Celene B Mulholland
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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32
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Herial NA, Khan AA, Sherr GT, Qureshi MH, Suri MFK, Qureshi AI. Detachable-Tip Microcatheters for Liquid Embolization of Brain Arteriovenous Malformations and Fistulas: A United States Single-Center Experience. Neurosurgery 2016; 11 Suppl 3:404-11; discussion 411. [PMID: 26083156 DOI: 10.1227/neu.0000000000000839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The US Food and Drug Administration recently approved a detachable-tip microcatheter, the Apollo microcatheter (eV3, Inc, Irvine, California), to prevent catheter entrapment during embolization of brain arteriovenous malformations (AVMs) using liquid embolic systems. OBJECTIVE To report technical aspects and clinical results of cerebral embolizations with the Apollo microcatheter in 7 embolizations in 3 adult patients. METHODS A 62-year-old man presented with an AVM in the parieto-occipital region measuring 3.6 × 1.6 cm with major cortical feeders from the right middle cerebral artery (MCA) and minor contribution from the distal right anterior cerebral artery. Two pedicles originating from the MCA were embolized. A 48-year-old woman presented with a left frontal AVM measuring 3.3 × 1.8 cm with arterial feeders from the left MCA, left middle meningeal artery, and contralateral anterior cerebral artery. Three pedicles originating from the left MCA were embolized. A 76-year-old man presented with an arteriovenous fistula with multiple fistulous connections and feeders from both vertebral and occipital arteries and the left posterior cerebral artery draining into the left transverse, torcula, and left sigmoid sinus. Two major occipital artery feeders were embolized. RESULTS Seven Apollo microcatheters were used with the Onyx 18 liquid embolic system. The length of the detachable tip was 15 mm in 2 and 30 mm in 5 embolizations. The mean microcatheter in-position time within the pedicle was 20 minutes. Detachment of tip occurred in 3 instances. No limitations in accessing target arterial feeders and safe tip disengagement were noted despite prolonged injection times. CONCLUSION Our initial experience supports the feasibility, safety, and effectiveness of detachable-tip microcatheters in treating brain AVMs and arteriovenous fistulas.
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Affiliation(s)
- Nabeel A Herial
- *Zeenat Qureshi Stroke Institute and ‡Department of Neurosurgery, CentraCare Health, St. Cloud, Minnesota
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33
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YAMAMOTO T, NAKAO Y, WATANABE M, KIMURA T, SUGA Y, SUGIYAMA N. Surgical Approaches to the Borden Type III Dural Arteriovenous Fistula. ACTA ACUST UNITED AC 2016. [DOI: 10.2335/scs.44.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Takuji YAMAMOTO
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
| | - Yasuaki NAKAO
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
| | - Mitsuya WATANABE
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
| | - Takaoki KIMURA
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
| | - Yasuo SUGA
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
| | - Natsuki SUGIYAMA
- Department of Neurosurgery, Juntendo University Shizuoka Hospital
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Takemoto K, Higashi T, Sakamoto S, Inoue T. Successful sinus restoration for transverse-sigmoid sinus dural arteriovenous fistula complicated by multiple venous sinus occlusions: The usefulness of preoperative computed tomography venography. Surg Neurol Int 2015; 6:137. [PMID: 26392914 PMCID: PMC4553663 DOI: 10.4103/2152-7806.163176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/25/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although sinus restoration for transverse-sigmoid sinus (TSS) dural arteriovenous fistula (DAVF) has rarely been reported over the past decade, its advantage and indication still remain unclear. Herein, we discuss the indications and technical aspects of this therapy with a review of the literature. CASE DESCRIPTION A 79-year-old female was referred to our department with generalized convulsion. An angiogram revealed a DAVF at the junction of the right TSS. The right sigmoid and left transverse sinuses were occluded, which resulted in remarkable leptomeningeal venous reflux and cerebral venous congestion. A preoperative computed tomography (CT) venogram precisely revealed the occluded segment of the right sigmoid sinus, which facilitated the sinus restoration with balloon percutaneous transluminal angioplasty and stenting. CONCLUSION Sinus restoration is preferable in patients with severe cerebral venous congestion due to multiple sinus occlusions and/or a restricted collateral venous outlet. CT venography is useful for precise evaluation of the length and configuration of the occluded segment, which thus make it possible to evaluate the feasibility of stenting.
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Affiliation(s)
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Signorelli F, Della Pepa G, Sabatino G, Marchese E, Maira G, Puca A, Albanese A. Diagnosis and management of dural arteriovenous fistulas: A 10 years single-center experience. Clin Neurol Neurosurg 2015; 128:123-9. [DOI: 10.1016/j.clineuro.2014.11.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/01/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
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36
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Endovascular Treatment of Transverse-Sigmoid Sinus Type I Dural Arteriovenous Shunts with Sinus Preservation for Patients with Intolerable Symptoms: Four Case Reports. Clin Neuroradiol 2014; 25:313-6. [PMID: 25192775 DOI: 10.1007/s00062-014-0343-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
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37
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Vanlandingham M, Fox B, Hoit D, Elijovich L, Arthur AS. Endovascular treatment of intracranial dural arteriovenous fistulas. Neurosurgery 2014; 74 Suppl 1:S42-9. [PMID: 24402491 DOI: 10.1227/neu.0000000000000180] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Endovascular treatment options for dural arteriovenous fistulas (DAVFs) have vastly expanded and become progressively safer in the last several years. Angiographic imaging systems have improved, catheter technology has advanced, and liquid embolic and coil options have increased. As a likely result, an increasing proportion of DAVFs are treated via an endovascular approach. In addition to allowing physicians to appreciate and treat lesions better, varied approaches have been developed. The "plug and push" technique and the new availability of dimethyl sulfoxide--compatible dual lumen balloons have allowed safer and more thorough transarterial treatments. Transvenous treatment has proved to be a valuable technique for some lesions. Hybrid approaches with surgical assisted access to vascular structures have been successfully used to treat more challenging fistulas.
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Affiliation(s)
- Matthew Vanlandingham
- Semmes-Murphey Clinic, Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
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Pashapour A, Mohammadian R, Salehpour F, Sharifipour E, Mansourizade R, Mahdavifard A, Salehi M, Mirzaii F, Sariaslani P, Ardalani GF, Altafi D. Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. Neuroradiol J 2014; 27:461-70. [PMID: 25196621 DOI: 10.15274/nrj-2014-10079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/10/2014] [Indexed: 11/12/2022] Open
Abstract
Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.
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Affiliation(s)
- Ali Pashapour
- Neurology Department, Tabriz University of Medical Sciences; Tabriz, Iran - -
| | - Reza Mohammadian
- Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Firooz Salehpour
- Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran
| | | | - Ali Mahdavifard
- Ophthalmology Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Mohamadgharib Salehi
- Radiology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran
| | - Farhad Mirzaii
- Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Payam Sariaslani
- Neurology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran
| | | | - Davar Altafi
- Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran
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Kobayashi A, Salman RAS. Prognosis and Treatment of Intracranial Dural Arteriovenous Fistulae: A Systematic Review and Meta-Analysis. Int J Stroke 2014; 9:670-7. [DOI: 10.1111/ijs.12337] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
Background Dural arteriovenous fistulae can cause intracranial hemorrhage, but influences on this are unclear. Summary of review We searched Ovid MEDLINE (from 1966), Embase (from 1980), and the Cochrane Library in September 2013 for studies of ≥50 adults with dural arteriovenous fistulae describing death or intracranial hemorrhage. Of 16 studies of retrospective associations between dural arteriovenous fistulae vascular anatomy and prior mode of presentation, fistula location in the cavernous sinus was consistently associated with nonhemorrhagic modes of presentation; in five studies involving 855 patients, fistulae with retrograde leptomeningeal (cortical) venous drainage were associated with prior presentation with intracranial hemorrhage (pooled odds ratio 23·2, 95% CI 13·8 to 39·0; *** I2 = 0%). Future intracranial hemorrhage during untreated clinical course was statistically significantly associated with the presence of venous varix in one study and with presentation with intracranial hemorrhage in patients with retrograde leptomeningeal venous drainage in another. In 19 observational studies of treatment of dural arteriovenous fistulae involving 2329 patients, the pooled risk of death was 1·2% (95% CI 0·6 to 1·8, I2 = 35%), that of nonfatal intracranial haemorrhage was 0·5% (95%CI 0·2 to 0·8, I2 = 9%), and that of nonfatal cerebral infarction was 0·7% (95% CI 0·3 to 1·4, I2 = 52%), for a combined risk of 2·5% (95% CI 1·4 to 3·9, I2 = 69%). Conclusions Retrograde leptomeningeal venous drainage seems strongly associated with intracranial hemorrhage at presentation of dural arteriovenous fistula, but its association with subsequent intracranial hemorrhage is less clear. Short-term complications of dural arteriovenous fistula treatment affect 2–3% of patients in published reports.
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Affiliation(s)
- Adam Kobayashi
- Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) that shunt blood into the transverse or superior sagittal venous sinuses cause papilledema by raising intracranial pressure ("the papilledema shunt"). Such fistulas pose unique diagnostic and therapeutic challenges. METHODS Case report and literature review. RESULTS In a patient presenting with papilledema, non-invasive brain vascular imaging disclosed subtle signs of a DAVF. Digital angiography delineated the DAVF and revealed cortical venous reflux. After three transarterial embolizations with ethylene vinyl alcohol, the DAVF was closed and papilledema resolved. CONCLUSIONS The imaging features of a DAVF that cause papilledema may be subtle on non-invasive vascular imaging. If overlooked, and lumbar puncture is performed, there is a substantial risk of brain herniation. Cortical venous reflux, which may be relatively common in these DAVFs, impels the need for endovascular closure. The transvenous route, often employed for closing cavernous sinus DAVFs, should be avoided because of the dangers of dural venous sinus thrombosis.
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Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications. Neurosurg Rev 2013; 37:63-71. [DOI: 10.1007/s10143-013-0498-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/12/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
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Peng T, Liu A, Jia J, Jiang C, Li Y, Wu Z, Yang X. Risk factors for dural arteriovenous fistula intracranial hemorrhage. J Clin Neurosci 2013; 21:769-72. [PMID: 24291477 DOI: 10.1016/j.jocn.2013.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 11/18/2022]
Abstract
To our knowledge, the risk factors for intracranial hemorrhage from dural arteriovenous fistula (DAVF) have not been systematically described, due to the complexity of their anatomy and low incidence. We performed this retrospective study to investigate the DAVF factors predicting intracranial hemorrhage. A 10year database of 144 consecutive patients with DAVF was reviewed. Data collected and analyzed were demographics, morphologic features of DAVF, sex, age, fistula flow rate, arterial supply, lesion location, and venous drainage pattern. Linear univariate and multivariate logistic regression analyses were used to evaluate the association between influencing factors and hemorrhage. A first linear univariate analysis was performed for all influencing factors, and showed that sex, lesion location, and venous drainage pattern were statistically significant in predicting intracranial hemorrhage (p<0.05). Secondary multivariate logistic regression analysis with sex, lesion location, and venous drainage pattern showed that only venous drainage pattern was statistically significant in predicting intracranial hemorrhage (p<0.05). Therefore, venous drainage pattern, particularly the cortical venous drainage, significantly predicts intracranial hemorrhage from DAVF. Both sex and lesion location may be confounding factors in predicting intracranial hemorrhage from DAVF, while the other factors may not be associated with hemorrhage.
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Affiliation(s)
- Tangming Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China.
| | - Jianwen Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing 100050, China
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Pan DHC, Lee CC, Wu HM, Chung WY, Yang HC, Lin CJ. Gamma Knife radiosurgery for the management of intracranial dural arteriovenous fistulas. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 116:113-9. [PMID: 23417468 DOI: 10.1007/978-3-7091-1376-9_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND This report presents our 15-year experience with Gamma Knife radiosurgery (GKS) for the treatment of 321 patients with dural arteriovenous fistulas (DAVFs) in different locations. METHODS The most common locations of DAVFs were the cavernous sinus (206 cases) and transverse-sigmoid sinus (72 cases), which together accounted for 86.6 % of cases. In all, 54 patients had undergone embolization or surgery prior to radiosurgery, and the other patients underwent GKS as the primary treatment. During GKS, radiation was confined to the involved sinus wall, which was considered the true nidus of the DAVF. Target volume ranged from 0.8 to 52 cm(3). Marginal and maximum doses to the nidus ranged from 14 to 25 Gy and from 25 to 36 Gy, respectively. RESULTS The mean follow-up time was 28 months (range 2-149 months). In 264 of 321 patients (82 %) available for follow-up study, 173 (66 %) showed complete obliteration of DAVFs with symptomatic resolution, 87 (33 %) had partial obliteration, 2 (0.8 %) had stationary status, 1 (0.4 %) had progression, and 1 (0.4 %) died from a new hemorrhagic episode. Complications were found in only two (0.8 %) patients, one with venous hemorrhage and one with focal brain edema after GKS. CONCLUSIONS GKS is a safe, effective treatment for DAVFs. It provides a minimally invasive therapeutic option for patients who harbor less-aggressive DAVFs but who suffer from intolerable clinical symptoms. For some aggressive DAVFs with extensive venous hypertension or hemorrhage, multimodal treatment with combined embolization or surgery is necessary.
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Affiliation(s)
- David Hung-Chi Pan
- Department of Neurosurgery, Taipei Veterans General Hospital, No. 201 Shi-Pai Rd., Sec. 2, Taipei, Taiwan.
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Baik SK, Kim YW, Lee SW, Choi CH, Park J. A treatment option for nontraumatic adult-type dural arteriovenous fistulas: transarterial venous coil embolization. World Neurosurg 2013; 82:417-22. [PMID: 23743218 DOI: 10.1016/j.wneu.2013.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transvenous coil embolization of the affected venous outlet is the most effective treatment method for the management of nontraumatic adult dural arteriovenous fistulas (DAVFs). However, such an approach is not always feasible. We discuss nontraumatic adult DAVFs that were treated with transarterial coil embolization of the proximal venous outlet at our facility, as well as cases previously reported in the literature. METHODS This study included 8 patients who had undergone transarterial coil embolization of the proximal venous outlet for the treatment of nontraumatic adult DAVFs (4 cases in our series and 4 cases in the literature). All clinical, angiographic, and procedural data were retrospectively collected from medical charts or the literature and recorded on standardized forms by a physician. The DAVFs were classified according to the venous drainage pattern. RESULTS In all 8 patients, occlusion of the proximal venous site of the fistula was possible by using coils through the arterial feeders; this resulted in complete recovery in all patients. The access route for 7 of the 8 cases was the middle meningeal artery, and in 1 case was the meningohypophyseal artery. In all 8 patients the access artery was relatively smooth, with distal enlargement in the fistula region. CONCLUSIONS If a distally enlarged feeding artery is observed among the multiple feeding arteries, it suggests the existence of a large fistula and may serve as an access route for transarterial venous coil embolization. This procedure may offer a more effective and safer treatment than other endovascular approaches.
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Affiliation(s)
- Seung Kug Baik
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
| | - Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jaechan Park
- Department of Neurosurgery, Science and Engineering Institute, Kyungpook National University College of Medicine, Daegu, Korea
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Abdihalim MM, Hassan AE, Qureshi AI. Off-label use of drugs and devices in the neuroendovascular suite. AJNR Am J Neuroradiol 2013; 34:2054-63. [PMID: 23518356 DOI: 10.3174/ajnr.a3447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY The off-label use of drugs and devices in neuroendovascular procedures is common. Neurointerventionalists should be well aware of the level of evidence available in support of the off-label use of drugs and devices in their practice and some of the potential adverse events associated with them. These uses are categorized as I or II if they have been evaluated as primary or ancillary interventions in prospective trials/registries of neuroendovascular procedures and III if they were evaluated in case series. Category IV use is based on evaluation as primary or ancillary interventions in prospective trials/registries of non-neuroendovascular procedures. Physicians are allowed to use off-label drugs and procedures if there is strong evidence that they are beneficial for the patient. The neurointerventional professional societies agree that off-label use of drugs and devices is an important part of the specialty, but practicing providers should base their decisions on sound evidence when using such drugs and devices.
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Alexander MD, English J, Hetts SW. Occipital artery anastomosis to vertebral artery causing pulsatile tinnitus. J Neurointerv Surg 2013; 6:e15. [DOI: 10.1136/neurintsurg-2012-010632.rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Eftekhar B, Morgan MK. Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients. J Clin Neurosci 2013; 20:532-5. [PMID: 23352348 DOI: 10.1016/j.jocn.2012.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/06/2012] [Indexed: 12/01/2022]
Abstract
A retrospective study was performed to analyse a prospectively collected database from a single surgeon (M.K.M.) of transverse-sigmoid sinus dural arteriovenous fistulas (DAVF) between 1991 and August 2011. During the study period, 144 patients with 160 DAVF were managed. Sixty-five of the DAVF were located in the transverse-sigmoid sinus and 42 were treated with surgery, or embolisation and surgery. All patients who underwent surgery were symptomatic with retrograde cortical venous drainage. The average follow-up period was 18months (range, 2-82months). Total elimination of the DAVF was achieved in all instances, including two patients (5%) who required further surgery after postoperative cerebral angiography showed that some venous drainage had persisted after the first operation. There was no new permanent neurological deficit or mortality attributable to surgery. Our institutional experience shows that in selected patients with transverse-sigmoid sinus DAVF, the involved sinus can be surgically resected with a high success rate and it is as safe as many alternative options. We suggest that this definitive treatment option should be offered to patients, and the outcome should be compared to other treatment modalities.
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Affiliation(s)
- Behzad Eftekhar
- Australian School of Advanced Medicine, Macquarie University, New South Wales 2109, Australia.
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Cho WS, Han JH, Kang HS, Kim JE, Kwon OK, Oh CW, Han MH, Chung YS. Treatment outcomes of intracranial dural arteriovenous fistulas of the transverse and sigmoid sinuses from a single institute in Asia. J Clin Neurosci 2013; 20:1007-12. [PMID: 23313518 DOI: 10.1016/j.jocn.2012.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/15/2012] [Accepted: 03/17/2012] [Indexed: 10/27/2022]
Abstract
Intracranial dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses (TSS) are rare in Asian populations. This study sought to evaluate the treatment outcomes of intracranial TSS DAVFs at a single Asian institute. Between 1989 and 2007, 122 patients presented to the Seoul National University Hospital with intracranial DAVFs; we performed a retrospective analysis of the 38 patients (31.1%) with TSS DAVFs. The common clinical presentations were headache (44.7%), tinnitus (39.5%), and intracranial hemorrhage (26.3%), and 71.1% had Borden type II or III lesions. Two patients were conservatively managed, two underwent surgery, and 34 were treated endovascularly with transarterial embolization (TAE), transvenous embolization (TVE), or both. The complete occlusion rate immediately after treatment was 50%. Of the 31 patients (81.6%) who underwent follow-up angiography, initial complete occlusion was achieved in 51.6%, and, at the last follow-up, the complete occlusion rate was 64.5%, with the surgery and TVE groups achieving 100% occlusion. The clinical cure rate was 34.2%, and 86.8% of patients had a favorable clinical outcome. However, all patients in both the surgery and TVE groups achieved a favorable clinical outcome. Four (26.7%) of 15 lesions with initially partial embolization showed delayed occlusion. Five patients (13.2%) exhibited clinical or angiographic signs of recurrence, and five patients had permanent complications. TSS DAVFs were less common than cavernous sinus DAVFs, unlike in Western countries, but the angiographic and clinical characteristics of TSS DAVFs were similar to those in Western countries. TSS DAVFs were successfully managed with different modalities, but both surgery and TVE were superior to conservative management or TAE.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon-do, Republic of Korea
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Santillan A, Nanaszko M, Burkhardt JK, Patsalides A, Gobin YP, Riina HA. Endovascular management of intracranial dural arteriovenous fistulas: a review. Clin Neurol Neurosurg 2012; 115:241-51. [PMID: 23287743 DOI: 10.1016/j.clineuro.2012.11.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 11/11/2012] [Accepted: 11/24/2012] [Indexed: 01/13/2023]
Abstract
Dural arteriovenous fistulas (DAVFs) are rare pathological entities presenting with a diverse clinical course, ranging from benign to life-threatening. Digital subtraction angiography remains the gold standard in the diagnosis of clinically suspected DAVFs. This article reviews the ethiopathogenesis, natural history, classification systems, clinical and angiographic features, and the current treatment strategies for these complex lesions. The management of DAVFs may include conservative treatment, endovascular intervention, microsurgery, and stereotactic radiosurgery. A multidisciplinary approach involving a neurosurgeon, interventional neuroradiologist, and neurologist is required before considering any type of treatment modality. The indication for the best therapeutic alternative must be individualized for each patient.
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Affiliation(s)
- Alejandro Santillan
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States.
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Jittapiromsak P, Ikka L, Benachour N, Spelle L, Moret J. Transvenous balloon-assisted transarterial Onyx embolization of transverse–sigmoid dural arteriovenous malformation. Neuroradiology 2012. [DOI: 10.1007/s00234-012-1107-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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