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Sugihara M, Fujita A, Ikeuchi Y, Hori T, Kohta M, Tanaka K, Kimura H, Sasayama T. Combined transarterial and transvenous embolization of anterior cranial fossa dural arteriovenous fistula. Surg Neurol Int 2023; 14:277. [PMID: 37680916 PMCID: PMC10481809 DOI: 10.25259/sni_487_2023] [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: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023] Open
Abstract
Background Excessive glue injection into the drainage vein in patients with dural arteriovenous fistula (dAVF) can result in venous obstruction. We performed transarterial embolization (TAE) combined with transvenous embolization (TVE) with coils to prevent the glue from migrating into the normal cortical veins. Case Description A 57-year-old man was pointed out to have a Borden Type III anterior cranial fossa dAVF during a check-up for putaminal hemorrhage. Because a left frontal normal cortical vein drained into the pathological drainage vein, excessive glue injection into the drainage vein may have caused venous obstruction. We performed TVE with coils at the foot of the draining vein to prevent excessive migration of glue into the drainer, followed by TAE with glue. With this technique, complete obliteration of the shunt without venous ischemia was obtained. Conclusion The combined treatment of TAE and TVE is effective in preventing venous ischemia caused by unintended migration of glue cast into the drainage vein.
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Affiliation(s)
- Masahiro Sugihara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Uchida M, Tanikawa M, Nishikawa Y, Yamanaka T, Ueki T, Mase M. Endoscope-Controlled High Frontal Approach for Dural Arteriovenous Fistula in Anterior Cranial Fossa. World Neurosurg 2023; 175:e421-e427. [PMID: 37019304 DOI: 10.1016/j.wneu.2023.03.116] [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: 10/28/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Currently, surgical obliterations are a mainstay for treating dural arteriovenous fistula (DAVF) in the anterior cranial fossa (ACF), which has high risks of hemorrhage and functional disorder. By introducing an endoscope into a high frontal approach and utilizing its advantages, we attempted to establish it as a new surgical procedure that eliminates the drawbacks of various approaches that have been used to date. METHODS By using 30 clinical datasets of venous-phase head computed tomography angiogram, measurements and comparisons on a 3-dimensional workstation were performed to identify the appropriate positioning of keyhole craniotomy for endoscope-controlled high frontal approach (EHFA). Based on these data, a cadaver-based surgery was simulated to verify the feasibility of EHFA and develop an efficient procedure. RESULTS In EHFA, though raising the position of the keyhole craniotomy made the operative field deeper, significant advantages were obtained in the angle between the operative axis and the medial-anterior cranial base and the amount of bone removal required at the anterior edge of craniotomy. Minimally invasive EHFA, performed through a keyhole craniotomy without opening the frontal sinus, proved to be feasible on 10 sides of 5 cadaver heads. Moreover, 3 patients with DAVF in ACF were successfully treated by clipping the fistula via EHFA. CONCLUSIONS EHFA, which provided a direct corridor to the medial ACF at the level of the foramen cecum and crista galli and the minimum necessary operative field, was found to be a suitable procedure for clipping the fistula of DAVF in ACF.
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Affiliation(s)
- Mitsuru Uchida
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yusuke Nishikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomoyasu Yamanaka
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takatoshi Ueki
- Department of Integrative Anatomy, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Iwata T, Toyota S, Kudo A, Nakagawa K, Shimizu T, Murakami T, Mori K, Taki T, Kishima H. Microsurgery "Under the Eaves" Using ORBEYE: A Case of Dural Arteriovenous Fistula of the Anterior Cranial Fossa. World Neurosurg 2020; 138:178-181. [PMID: 32156593 DOI: 10.1016/j.wneu.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND One of the merits of exoscopes, including ORBEYE, is that they are superior to a microscope in terms of ergonomic features. We report a case of dural arteriovenous fistula (dAVF) that was cured by direct surgery using the ergonomic advantages of ORBEYE. CASE DESCRIPTION A 78-year-old man was found to have dAVF of the anterior cranial fossa incidentally. We performed direct surgery via bifrontal craniotomy. Because the frontal sinus was large, we reserved the frontal bone-like eaves in order not to open the frontal sinus. The vertex of his head was sufficiently down to shift the frontal lobe downward with gravity. During surgery, we set the angle of the operative visual axis of ORBEYE approximately horizontal to avoid the reserved frontal bone. We performed a stable operation using ORBEYE in a comfortable posture. CONCLUSIONS ORBEYE facilitates ergonomic microsurgery, even under the eaves, with the angle of the operative visual axis approximately horizontal using gravity.
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Affiliation(s)
- Takamitsu Iwata
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
| | - Akira Kudo
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kanji Nakagawa
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takeshi Shimizu
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kanji Mori
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takuyu Taki
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Medical School, Osaka, Japan
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Jang JH, Cho WS, Kang HS, Kim JE. Surgical Obliteration of Anterior Cranial Fossa Dural Arteriovenous Fistulas via Unilateral High Frontal Craniotomy. World Neurosurg 2019; 130:89-94. [PMID: 31284056 DOI: 10.1016/j.wneu.2019.06.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical obliteration is generally recommended for anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) because of a high risk of bleeding and the difficulty of endovascular approaches. Surgical obliteration is generally performed via a frontobasal craniotomy; however, it is slightly excessive over the target fistula. Here, we present 2 cases of ACF DAVFs treated with small craniotomy without frontal sinus involvement and a review of the related literature. METHODS We present 2 cases including a 63-year-old woman who presented with a right-sided ACF DAVF that was fed by both ethmoidal arteries and drained into the right cortical veins (case 1) and a 59-year-old man with right-sided unruptured multiple aneurysms and a left-sided ACF DAVF that was fed by the right ethmoidal artery and drained into the left cortical veins (case 2). RESULTS Case 1 underwent surgical obliteration via a right high frontal craniotomy. Case 2 was simultaneously treated with surgical clipping of the multiple aneurysms via a right lateral supraorbital craniotomy and surgical obliteration of the ACF DAVF via a left high frontal craniotomy. These 2 patients had no neurologic deficits, and complete obliteration of all the lesions was confirmed on cerebral angiography. CONCLUSIONS Constructing a small corridor and a deep working distance in unilateral small high frontal craniotomy may be a slightly unusual approach; however, it is thought to provide sufficient space and a range of microscopic views that facilitate surgical manipulation without requiring extensive bone work.
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Affiliation(s)
- Je Hun Jang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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Xu K, Ji T, Li C, Yu J. Current status of endovascular treatment for dural arteriovenous fistulae in the anterior cranial fossa: A systematic literature review. Int J Med Sci 2019; 16:203-211. [PMID: 30745800 PMCID: PMC6367520 DOI: 10.7150/ijms.29637] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/04/2018] [Indexed: 01/20/2023] Open
Abstract
Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVFs) are rare, and a systematic review of the literature is lacking. Such a review is necessary, however, so a systematic PubMed search of related studies was performed. Twenty-four studies were identified, reporting on 48 patients, of whom 39 had definite age and sex information and 33 (84.6%, 33/39) were male. The afflicted patients were between 37 and 80 years old (mean 55.6). Among the 48 patients, 28 (58.3%, 28/48) primarily presented with intracranial hemorrhage, 47 (97.9%, 47/48) had feeding arteries from the anterior ethmoidal artery (AEA) of the ophthalmic artery (OA), and 40 (83.3%, 40/48) had bilateral feeding arteries. All of the cases had high-grade Cognard classifications (III-IV). Among the 48 patients, 43 (89.6%, 43/48) had drainage into the superior sagittal sinus (SSS). In addition, 36 (75%, 36/48) patients were treated via transarterial embolization (TAE). Of these patients, 28 (77.8%, 28/36) were managed via the AEA of the OA. Another 12 (25%, 12/48) patients were treated via transvenous embolization (TVE), 11 of whom (91.7%, 11/12) were treated with the trans-SSS approach. Complete angiographic cure was achieved in 44 (91.7%, 44/48) patients, with 4 (8.3%, 4/48) patients suffering from postprocedural complications. All 48 patients had clear descriptions of follow-up outcomes, with 45 (93.8%, 45/48) patients having a good outcome. Thus, when treating ACF DAVFs, endovascular treatment (EVT) can completely obliterate the fistula point and correct the venous shunting. EVT is therefore an effective treatment for ACF DAVF. Although many complications can occur, this approach achieves good outcomes in most cases.
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Affiliation(s)
- Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Tiefeng Ji
- Department of Radiology, 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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Johnson SA, Cox B, Ho ML, Murphy M, Scharf E. Anterior Cranial Fossa Dural Arteriovenous Fistula Presenting as Recurrent Multifocal Lobar Intracerebral Hemorrhages: A Case Report. Neurohospitalist 2018; 9:109-112. [PMID: 30915190 DOI: 10.1177/1941874418797797] [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: 11/15/2022] Open
Abstract
We report a unique case and presentation of a 77-year-old man with atrial fibrillation who presented with complex imaging features, including bifrontal cerebral hematomas that progressed to multifocal macro- and microhemorrhages, vasogenic edema, and cortical/meningeal enhancement. Cerebrospinal fluid analysis was only remarkable for a protein elevation of 65 mg/dL. Leptomeningeal vessel biopsy failed to demonstrate evidence of amyloid angiopathy but did show concentric obstructive intimal fibroplasia, suggestive of chronic venous congestion. Conventional cerebral angiography showed a Cognard type IV dural arteriovenous fistulae fed by bilateral ethmoidal arteries draining directly into ectatic cortical veins. A chronic occlusion of the anterior third of the superior sagittal sinus was also noted. The fistula was successfully surgically obliterated via an uncomplicated left frontal craniotomy approach. After rehabilitation therapy, he was discharged home with a modified Rankin Scale score of 3. Because effective treatment exists, this case underscores the importance of identifying this rare etiology of intracerebral hemorrhage and pursuing adequate workup.
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Affiliation(s)
| | - Benjamin Cox
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mai Lan Ho
- Department of Radiology, Mayo Clinic Rochester, MN, USA
| | - Meghan Murphy
- Department of Neurosurgery, Mayo Clinic Rochester, MN, USA
| | - Eugene Scharf
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Carotid Cavernous Sinus Fistulas Without Superior Ophthalmic Vein Enlargement. Ophthalmic Plast Reconstr Surg 2015; 31:191-6. [DOI: 10.1097/iop.0000000000000241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spiotta AM, Hawk H, Kellogg RT, Turner RD, Chaudry MI, Turk AS. Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae. J Neurointerv Surg 2014; 6:195-9. [PMID: 23525571 DOI: 10.1136/neurintsurg-2012-010642] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Dural arteriovenous fistulae (dAVF) of the anterior fossa have a malignant course since they exclusively drain into cortical frontal veins and warrant aggressive treatment. Classically, these lesions have been treated with microsurgical clipping of the fistulous connection. We describe a transvenous approach for Onyx embolization of these lesions that relies on distal venous access using a flexible new-generation guide catheter. METHODS A retrospective review was performed of all patients with an anterior fossa dAVF treated at the Medical University of South Carolina since 2010. Charts, procedural records, angiographic images and follow-up were reviewed. Three patients were identified. RESULTS Transfemoral venous access and distal transvenous sinus access was obtained in a retrograde fashion to at least the level of the right transverse sinus. Once a distal guide catheter position was obtained within the venous sinus system, a microcatheter was advanced into the predominant draining anterior frontal cortical vein in preparation for embolization. Onyx 34 embolization was then initiated from this position with the objective of achieving penetration across the vascular shunt. CONCLUSIONS Our experience demonstrates that transvenous Onyx embolization offers an effective and safe alternative to the classic neurosurgical treatment of anterior fossa dAVF.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U SA
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Embolization of dural arteriovenous fistula of the anterior cranial fossa through the middle meningeal artery with Onyx. Clin Neurol Neurosurg 2013; 117:1-5. [PMID: 24438796 DOI: 10.1016/j.clineuro.2013.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 08/12/2013] [Accepted: 11/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Dural arteriovenous fistula (DAVF) of the anterior cranial fossa is usually treated by surgical disconnection or endovascular embolization via the ophthalmic artery. The middle meningeal artery is a rarely used approach. This study investigated the safety and efficacy of embolization of DAVF of the anterior cranial fossa with Onyx through the middle meningeal artery. METHODS A retrospective review of a prospective cerebral vascular disease database was performed. Patients with DAVF of the anterior cranial fossa managed with embolization through the middle meningeal artery with Onyx were selected. Information on demography, symptoms and signs, angiographic examinations, interventional treatments, angiographic and clinical results, and follow-up was collected and analyzed. RESULTS Five patients were included in this study, four of whom had hemorrhage. All fistulas were fed by the bilateral ethmoidal arteries arising from the ophthalmic artery and by the anterior branch of the middle meningeal artery. The abnormal shunt unilaterally drained into the superior sagittal sinus with interposition of the cortical veins all five patients. All endovascular treatments were successful with evidence of an angiographic cure. No complications occurred, and all patients recovered uneventfully without neurologic deficits. There were nearly no symptoms among the patients during follow-up. CONCLUSION Embolization of DAVF of the anterior cranial fossa via the middle meningeal artery with Onyx is safe, effective, and a good choice for management of DAVF. More cases are needed to verify these findings.
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