1
|
Oh SH, Choi JH, Kim BS, Shin YS. Transvenous embolization along with intraprocedural image fusion technique for complex intracranial dural arteriovenous fistula. Acta Neurochir (Wien) 2023; 165:3769-3777. [PMID: 38008798 DOI: 10.1007/s00701-023-05853-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/15/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE This study aimed to investigate the efficacy and safety of an intraprocedural image fusion technique using flat-panel detector computed tomography-based rotational angiography (FDCT-RA) and image fusion (IF) for the transvenous approach in treating intracranial dural arteriovenous fistulas (dAVFs). METHODS A retrospective review was conducted on patients who underwent transvenous embolization for dural AVFs. The patients were classified into two groups according to the treatment technique used: the FDCT-RA and IF technique group and the conventional technique group. The primary outcomes assessed were the angiographic and clinical outcomes, complications, fluoroscopy time, and radiation exposure. Univariate analyses were performed to compare the two treatment modalities. RESULTS Eighty-six patients with intracranial dAVFs were treated with transvenous embolization (TVE), of which 37 patients underwent transvenous approach with flat-panel detector computed tomography-based rotational angiography (FDCT-RA) and image fusion (IF) technique used. The FDCT-RA and IF group showed difference in the location of dAVFs, occlusion state of the sinus, and access routes in comparison to the conventional treatment group. The FDCT-RA and IF technique was predominantly used for dAVFs involving the anterior condylar confluence and cavernous sinus with ipsilateral inferior petrosal sinus (IPS) occlusion. Patients treated with this technique demonstrated a higher rate of complete occlusion (91.9%, n = 34) compared to those treated with the conventional technique (79.6%, n = 39), but this difference was not statistically significant (p = 0.136). Although the implementation of this technique during the treatment procedure showed a tendency to decrease both fluoroscopy duration and radiation dose, the observed results did not reach statistical significance (p = 0.315, p = 0.130). CONCLUSION The intraprocedural image fusion technique using FDCT-RA for transvenous treatment of intracranial dAVFs could provide help in treatment of dAVFs of certain locations or access routes. It might provide aid in microcatheter navigation, without increasing the radiation exposure and fluoroscopy time.
Collapse
Affiliation(s)
- Sol Hooy Oh
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, 06591, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, 06591, Korea.
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, 06591, Korea
| |
Collapse
|
2
|
Alexander MD, Darflinger R, Cooke DL, Halbach VV. Cerebral arteriovenous fistulae. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:179-198. [PMID: 33272395 DOI: 10.1016/b978-0-444-64034-5.00004-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dural arteriovenous fistulae (dAVFs) are diverse, complex lesions that share the common feature of arteriovenous shunting without an intervening nidus. In this chapter, the ensuing discussion is organized by dAVF location, followed by further consideration of less common, distinct types of dAVFs-carotid cavernous fistulae, pial arteriovenous fistulae, and vein of Galen malformations. For each lesion type, epidemiology, clinical presentation, imaging findings, classification considerations, and treatment options are discussed.
Collapse
Affiliation(s)
- Matthew D Alexander
- Departments of Radiology and Imaging Sciences, and Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | | | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States.
| | - Van V Halbach
- Departments of Radiology and Biomedical Imaging, Neurological Surgery, Neurology, and Anesthesia and Perioperative Care, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| |
Collapse
|
3
|
Cassandro E, Cassandro C, Sequino G, Scarpa A, Petrolo C, Chiarella G. Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids. Case Rep Otolaryngol 2015; 2015:817313. [PMID: 26693371 PMCID: PMC4674581 DOI: 10.1155/2015/817313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/11/2015] [Indexed: 11/17/2022] Open
Abstract
While pulsatile tinnitus (PT) and dural arteriovenous fistula (DAVF) are not rarely associated, the finding of a conductive hearing loss (CHL) in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.
Collapse
Affiliation(s)
- Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Claudia Cassandro
- ENT Department, San Giovanni Battista Hospital, University of Torino, 10124 Torino, Italy
| | - Giuliano Sequino
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Claudio Petrolo
- Department of Experimental and Clinical Medicine, Audiology and Phoniatrics Unit, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Audiology and Phoniatrics Unit, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| |
Collapse
|
4
|
Pirodda A, Brandolini C, Cassandro E, Borghi C. Primary vascular dysregulation syndrome: Possible implications for inner ear acute diseases? Med Hypotheses 2015; 85:586-7. [PMID: 26321227 DOI: 10.1016/j.mehy.2015.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/19/2015] [Indexed: 11/18/2022]
Abstract
Primary vascular dysregulation syndrome has been reported as a possible cause for different eye diseases. Signs or symptoms of this syndrome not only may consist in a series of ocular disorders, as they possibly concern or are associated to various systemic conditions; even the damage of another terminal sensory organ as the inner ear is reported among the possible associations. Herein, the analogies between eye and inner ear are outlined, analyzing the PVD profile that well corresponds to our widely described model of subject without organic cardiovascular impairment but prone to inner ear acute disturbances. Actually, in absence of a recognized cause the latter can be due to a systemic dysregulation like the described one concerning ocular disorders.
Collapse
Affiliation(s)
- Antonio Pirodda
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Cristina Brandolini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| |
Collapse
|
5
|
Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol 2012; 33:1007-13. [PMID: 22241393 DOI: 10.3174/ajnr.a2798] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging. Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage.
Collapse
Affiliation(s)
- D Gandhi
- Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | |
Collapse
|
6
|
|
7
|
Cohen SD, Goins JL, Butler SG, Morris PP, Browne JD. Dural arteriovenous fistula: Diagnosis, treatment, and outcomes. Laryngoscope 2009; 119:293-7. [PMID: 19172609 DOI: 10.1002/lary.20084] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel D Cohen
- Department of Otolaryngology, Head & Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | | | | | | | | |
Collapse
|
8
|
Tirakotai W, Benes L, Kappus C, Sure U, Farhoud A, Bien S, Bertalanffy H. Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Neurosurg Rev 2006; 30:40-8; discussion 48-9. [PMID: 17109181 PMCID: PMC1705527 DOI: 10.1007/s10143-006-0056-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 09/02/2006] [Accepted: 09/03/2006] [Indexed: 10/30/2022]
Abstract
Dural arteriovenous fistulas located in the vicinity of the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. The authors comprehensively analyze multiple features in a series of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Four patients who underwent surgery via the transcondylar approach to treat dural arteriovenous fistulas around the jugular foramen were retrospectively reviewed. Previously, endovascular treatment was attempted in all patients. The success of the surgical treatment was examined with postoperative angiography. Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three patients, and significant flow reduction in one individual. All patients had a good postoperative outcome, and only one experienced mild hypoglossal nerve palsy. Despite extensive bone drilling, an occipitocervical fusion was necessary in only one patient with bilateral lesions. The use of an individually tailored transcondylar approach to treat dural arteriovenous fistulas at the region of the jugular foramen is most effective. This approach allows for complete obliteration of the connecting arterial feeders, and removal of bony structures containing pathological vessels.
Collapse
Affiliation(s)
- W Tirakotai
- Department of Neurosurgery, University Hospital Marburg, 35043 Marburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
9
|
Branstetter BF, Weissman JL. The radiologic evaluation of tinnitus. Eur Radiol 2006; 16:2792-802. [PMID: 16718451 DOI: 10.1007/s00330-006-0306-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/14/2006] [Indexed: 11/26/2022]
Abstract
Tinnitus ("ringing in the ears") is a prevalent symptom in the general population, and often brings patients to medical attention. Many causes of tinnitus are evident radiographically. The most frequently-encountered causes of tinnitus are discussed, and imaging recommendations are provided.
Collapse
Affiliation(s)
- Barton F Branstetter
- Department of Radiology and Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
10
|
Abstract
Tinnitus, a buzzing or ringing in the ear, may be pulsatile or continuous (nonpulsatile). The distinction, with a detailed clinical evaluation, determines the most appropriate imaging study. Pulsatile tinnitus suggests a vascular neoplasm, vascular anomaly, or vascular malformation. Most of the neoplasms are glomus tympanicum and glomus jugulare tumors. Vascular anomalies may cause pulsatile tinnitus, but the mechanism is unknown, and another (treatable) cause should be sought. Most neoplasms and anomalies are best seen on bone algorithm computed tomographic (CT) studies. Dural vascular malformations are often elusive on all cross-sectional imaging studies; conventional angiography may be necessary to make this diagnosis. Flow-sensitive magnetic resonance (MR) images show vascular loops compressing the eighth cranial nerve. Carotid dissections, aneurysms, atherosclerosis, and fibromuscular dysplasia can be identified on both MR imaging or MR angiographic studies and CT or CT angiographic studies. Otosclerosis and Paget disease are CT diagnoses. Benign intracranial hypertension often has no abnormal imaging findings. For patients with nonpulsatile tinnitus, MR imaging is the study of choice to exclude a vestibular schwannoma or other neoplasm of the cerebellopontine angle cistern. Multiple sclerosis and a Chiari I malformation are rare causes of pulsatile tinnitus, also best seen on MR studies. Many patients with tinnitus have no abnormal imaging findings.
Collapse
Affiliation(s)
- J L Weissman
- Department of Radiology and Otolaryngology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Mail Code CR-135, Portland, OR 97201-3098, USA.
| | | |
Collapse
|
11
|
Klinge PM, Herzog T, Lesinski-Schiedat A, Becker H. Superselektive Angiographie der Arteria occipitalis bei pulssynchronem Tinnitus. Clin Neuroradiol 1999. [DOI: 10.1007/bf03043398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|