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Alkiswani AR, Heskett C, Fry L, Gausper A, Le K, Brake A, Lei C, De Stefano FA, Madarang EJ, Peterson J, Ebersole K. Aneurysm of the Artery of Wollschlaeger and Wollschlaeger. Neuroradiol J 2024:19714009241240057. [PMID: 38491480 DOI: 10.1177/19714009241240057] [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: 03/18/2024] Open
Abstract
The Artery of Wollschlaeger and Wollschlaeger (AWW) is a non-eloquent, tentorial branch of the superior cerebellar artery (SCA). Coursing posteriorly from an intradural origin, the AWW passes through the ambient cistern and supplies the medial tentorium. Due to its small diameter, the AWW is often only identified in the context of secondary dilation from pathologies such as dural arteriovenous fistulas (DAVF). Herein, we report the first case, to our knowledge, of an aneurysm of the AWW associated with a posterior fossa DAVF Swift identification and diagnosis followed by cautious treatment of both the aneurysm and fistula were critical to avert rupture and optimize outcomes, avoiding potential hemorrhagic complications.
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Affiliation(s)
| | - Cody Heskett
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Lane Fry
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Adeesya Gausper
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kevin Le
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Aaron Brake
- The University of Kansas School of Medicine, Kansas City, KS, USA
- Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Catherine Lei
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ernest J Madarang
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Tong X, Ye M, Li J, Hu P, Hong T, Zhang P, Zhang H. Transvenous Onyx embolization for dural arteriovenous fistula with concomitant transvenous balloon protection of the venous sinus. J Neurosurg Sci 2024; 68:89-100. [PMID: 32347677 DOI: 10.23736/s0390-5616.20.04937-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the technical efficacy and safety of transvenous Onyx embolization for dural arteriovenous fistulas (DAVFs) with concomitant transvenous balloon protection of the venous sinus when transarterial route failed or was not feasible. METHODS Between September 2010 and December 2016, thirty-six patients presenting with intracranial DAVFs underwent transvenous balloon-assisted Onyx embolization. The technical efficacy, treatment-related complications, and angiographic and clinical outcomes were reviewed from our prospectively maintained DAVF database. RESULTS According to the Cognard Classification, 11 patients presented with clinically symptomatic Cognard type I; 11 cases with Cognard type IIa; 10 cases with Cognard type IIb; and 4 cases with Cognard type IIa+b. Complete angiographic occlusion of the DAVFs at the latest follow-up (mean 18 months after transvenous embolization) was achieved in 28 patients (77.8%), near-complete angiographic occlusion with minimal residual fistula in 5 patients (13.9%) and significant flow reduction of the DAVF in 2 patients (5.6%) and residual fistula for further treatment in 1 (2.8%) patient. Total clinical cure or remission of the pretreatment symptoms was achieved in 31 patients (31/36, 86.1%; 26 and 5 cases respectively). Affected venous sinus was preserved in 28 patients, intentionally occluded in 7 patients and gradually occluded in 1 patient. There were no immediate or long-term persistent complications after treatment. CONCLUSIONS Transvenous Onyx embolization of dural arteriovenous fistulas with combined transvenous balloon protection of the venous sinus is safe and effective in achieving high occlusion rate, low embolization-related complications and satisfactory clinical outcomes.
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Affiliation(s)
- Xianzeng Tong
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingwei Li
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China -
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Dural Arteriovenous Malformations. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Sardana H, Agrawal D, Manjunath N. Gamma Knife Radiosurgery: The Gold Standard Treatment for Intracranial Dural Arteriovenous Fistulas without Cortical Venous Drainage. Neurol India 2020; 68:815-820. [PMID: 32859819 DOI: 10.4103/0028-3886.293482] [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: 11/04/2022]
Abstract
Context Endovascular therapy is currently the most common treatment approach for intracranial dural arteriovenous fistula (DAVF), followed by microsurgery. Gamma Knife radiosurgery (GKS) is usually reserved as the last modality of treatment of intracranial DAVF. Aim To evaluate the clinical and radiological outcome of GKS in the treatment of DAVF without CVD. Subjects and Methods This series includes patients who underwent GKS for intracranial DAVF without CVD over 10 years (Jan 2007 to Dec 2016) in All India Institute of Medical Sciences, New Delhi. Their demographic profile, clinical presentation, imaging details, GKS details, and follow-up clinical status were obtained retrospectively. Clinical follow-up, along with radiological assessment using MRI every 6 months was done after GKS. DSA was performed once MRI strongly suggested obliteration of DAVF. Patients who had a clinical follow-up of less than 1 year were excluded from the study. Results 5 patients (4 males and 1 female) who had DAVF without CVD were included the study. The mean age was 44.8 years. All patients had complete obliteration of fistula on digital subtraction angiography (DSA) at a mean duration of 24 months post GKS. All patients had complete resolution of symptoms at the last follow-up. Conclusions Gamma Knife surgery is the most effective and the safest treatment modality for dealing with DAVFs without CVD. Instead of reserving it as the last resort for patients with DAVF without CVD, it should be considered as the gold standard treatment for DAVFs without CVD.
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Affiliation(s)
- Hardik Sardana
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Niveditha Manjunath
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
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Outcomes After Onyx Embolization as Primary Treatment for Cranial Dural Arteriovenous Fistula in the Past Decade. Acad Radiol 2020; 27:e123-e131. [PMID: 31445824 DOI: 10.1016/j.acra.2019.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES This retrospective single-center study aims to evaluate endovascular therapy (EVT) of cranial dural arteriovenous fistulas (dAVF) with ethylene vinyl alcohol (EVOH) copolymer (Onyx) regarding occlusion rates, complications, and recurrences. MATERIAL AND METHODS From January 2008 to April 2018, 75 patients with dAVF (41 men, 34 women; mean age 56 years) underwent EVT with the nonadhesive liquid embolic agent as primary treatment. Patient records and angiograms were reviewed for demographic data, symptoms, fistula type and size, number of EVTs, amount of embolic material, occlusion rates, and recurrences. RESULTS Seventy-five patients with dAVFs were primarily embolized with EVOH in 96 EVTs. According to the Merland-Cognard classification the majority of dAVFs treated were type 4 (42.7%), followed by type 2a (18.7%), type 2a+b (17.3%), type 1 (8%), type 2b (5.3%), type 3 (5.3%), and type 5 (2.7%). Complete occlusion (CO) of the dAVF was achieved in 45/75 (60%) of cases after a single EVT and in 58 (77%) patients after one or several EVTs. Seven patients (9%) required additional surgical therapy for CO. Successful treatment was achieved for 70/75 (93%) patients including 10 (13%) patients with residual dAVFs type 1-2a. Recurrence after CO occurred in one (1.3%) patient and four (5.3%) patients remained refractory to therapy with dAVFs type > 2a. Procedure-related permanent morbidity occurred in 4/75 (5.3%) patients. CONCLUSION For more than a decade transarterial EVOH embolization has established as the first-line treatment for cranial dAVFs with high cure rates and low rates of complications and recurrences. Additional neurosurgical therapy is rarely required for curative treatment.
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Johnson CS, Chiu A, Cheung A, Wenderoth J. Embolization of cranial dural arteriovenous fistulas in the liquid embolic era: A Sydney experience. J Clin Neurosci 2017; 49:62-70. [PMID: 29292012 DOI: 10.1016/j.jocn.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/16/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
Endovascular management of dural arteriovenous fistulas has become a mainstay of treatment. In particular, modern techniques have allowed greater fistula penetration and likelihood of complete obliteration. However, the efficacy of newer agents has not been quantified outside of predominantly small case reports and case series. Furthermore, the Australian experience with fistula embolization has yet to be reported in the literature. To this aim, we performed a retrospective review of our endovascular management of a large cohort of cranial dural arteriovenous fistulas in the liquid embolic era. This retrospective case series included ninety-six consecutive patients of any Cognard grade, treated between 2005 and 2016. Liquid embolic agents were used exclusively in eighty-three cases. The overall complete obliteration rate was 89.6% with a residual fistula rate of 2%, and complication rate of 8.3%. This Sydney, Australia cohort demonstrates excellent treatment effect and safety outcomes and thus supports the primary treatment of this condition by endovascular means.
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Affiliation(s)
| | - Albert Chiu
- Prince of Wales Private Hospital, Prince of Wales Hospital, Liverpool Hospital, Sydney Neurointerventional Specialists (SNIS), Suite 19, Level 7, Randwick NSW 2031, Australia.
| | - Andrew Cheung
- Prince of Wales Private Hospital, Prince of Wales Hospital, Liverpool Hospital, Sydney Neurointerventional Specialists (SNIS), Suite 19, Level 7, Randwick NSW 2031, Australia.
| | - Jason Wenderoth
- Prince of Wales Private Hospital, Prince of Wales Hospital, Liverpool Hospital, Sydney Neurointerventional Specialists (SNIS), Suite 19, Level 7, Randwick NSW 2031, Australia.
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Eliyas JK, Awad IA. Dural Arteriovenous Malformations. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Al-Mahfoudh R, Kirollos R, Mitchell P, Lee M, Nahser H, Javadpour M. Surgical Disconnection of the Cortical Venous Reflux for High-Grade Intracranial Dural Arteriovenous Fistulas. World Neurosurg 2015; 83:652-6. [DOI: 10.1016/j.wneu.2014.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/11/2014] [Indexed: 11/28/2022]
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Tian B, Xu B, Lu J, Liu Q, Wang L, Wang M. Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization. Eur J Radiol 2015; 84:1144-9. [PMID: 25818730 DOI: 10.1016/j.ejrad.2015.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/07/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. PATIENTS AND METHODS Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. RESULTS Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ=1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. CONCLUSION Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings.
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Affiliation(s)
- Bing Tian
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
| | - Bing Xu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
| | - Minjie Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Road, Shanghai, China.
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Kim SH, Chang WS, Jung HH, Chang JW. Delayed dural arteriovenous fistula after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 2014; 56:168-70. [PMID: 25328659 PMCID: PMC4200369 DOI: 10.3340/jkns.2014.56.2.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/04/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022] Open
Abstract
Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx® (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure.
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Affiliation(s)
- Sung Han Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Lv X, Wu Z, Li Y. Arteriovenous malformation in the brain: a theoretical study explaining the behavior of liquid embolic agents during endovascular treatment. Neuroradiol J 2013; 26:661-8. [PMID: 24355185 PMCID: PMC4202870 DOI: 10.1177/197140091302600609] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/01/2013] [Indexed: 02/05/2023] Open
Abstract
There is no theoretical study on blood flow in brain arteriovenous malformation (AVM). We present a numerical theory on AVM and liquid embolic agent AVM embolization. Darcy's law was used to compute flow relations for brain AVMs. Maag's formula was used to explain the diffuse patterns of N-butyl-2-cyanoacrylate (NBCA) and ethylene-vinyl alcohol copolymer (EVOH) in brain AVMs. According to Darcy's law, the instantaneous blood flow rate through an AVM is directly proportional to the pressure drop between two places in the AVM and indirectly proportional to the distance between them. The greater the pressure gradient (through the AVM), the greater the discharge rate, and the discharge rate of blood will often differ through different AVM (or even through the same AVM, in a different direction) even if the same pressure gradient exists in both cases. Subsequent to Darcy's initial discovery, Maag found that the radius of NBCA or EVOH diffusion is inversely proportional to their viscosity. Darcy's Law and Maag's formula could be used to analyze flow patterns of brain AVM and liquid embolic agent behavior in AVM near ideal.
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Affiliation(s)
- Xianli Lv
- />Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Zhongxue Wu
- />Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Youxiang Li
- />Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
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Piippo A, Niemelä M, van Popta J, Kangasniemi M, Rinne J, Jääskeläinen JE, Hernesniemi J. Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population. J Neurosurg 2012; 118:923-34. [PMID: 23259821 DOI: 10.3171/2012.11.jns111604] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Management of dural arteriovenous fistulas (DAVFs) has changed during the last decades due to increased knowledge of their pathophysiology and natural history as well as advances in treatment modalities. The authors describe the characteristics and long-term outcome of a large consecutive series of patients with DAVFs. METHODS Altogether 251 patients with 261 DAVFs were treated in 2 of the 5 neurosurgery departments at Helsinki and Kuopio University Hospitals between 1944 and 2006. Clinical data and radiological examinations were reviewed to assess patients' overall long-term clinical outcome. RESULTS The detection rate of DAVFs increased markedly in the 1970s and again in the 1990s when digital subtraction angiography was introduced. The incidence of DAVFs in a defined southern Finnish population was 0.51 per 100,000 individuals per year, which represents 32% of all the brain arteriovenous malformations. In the early part of the series, DAVFs were treated by proximal ligation of the feeding arteries. Later, most of the patients underwent preoperative embolization and subsequent craniotomy, and since 2000 stereotactic radiosurgery has been increasingly used in the treatment of DAVFs. Fifty-nine percent of the 261 fistulas were totally occluded. Treatment-related major complications were seen in 21 patients. CONCLUSIONS The advances in diagnostic methods (digital subtraction angiography, CT, and MRI) increased the detection rate of DAVFs, and as treatment modalities developed, the results of treatment and outcome of patients markedly improved with the introduction of endovascular techniques and stereotactic radiosurgery. Microsurgery is of limited use in DAVFs resistant to other treatment modalities.
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Affiliation(s)
- Anna Piippo
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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14
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Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z. The limitations and risks of transarterial Onyx injections in the treatment of grade I and II DAVFs. Eur J Radiol 2011; 80:e385-8. [PMID: 20837384 DOI: 10.1016/j.ejrad.2010.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Embolization of grade III-V intracranial DAVFs using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. This article is to evaluate the role of transarterial Onyx embolization in the treatment of grade I and II intracranial dural arteriovenous fistulas (DAVFs), including its limitations and risks. METHODS We retrospectively studied consecutive 26 patients (8 women and 18 men) treated for an grade I and II intracranial DAVF since 2006 in whom a transarterial approach was attempted with Onyx-18 embolization. There were 18 transverse-sigmoid sinus, 4 cavernous sinus, 2 superior sagittal sinus, 1 inferior petrosal sinus and 1 intradiploic fistulas. Five fistulas were Type I, 8 were Type IIa, and 13 were Type IIa+b, according to the Cognard classification. The mean clinical follow-up period was 15.6 months. RESULTS Anatomic cure was proven in 13 patients (50%) and clinical cure was obtained in 17 cases (65.4%). These 13 cures were achieved after a single procedure. All these 13 patients underwent a follow-up angiography, which has confirmed the complete cure. Partial occlusion was obtained in 13 patients. Complications were as follows: 2 cardiac Onyx migration, 2 reflexive bradyarrythmia, 1 transient visual hallucination, 2 transient fifth nerve palsies and 1 permanent seventh nerve palsy in inferior petrosal sinus DAVF. CONCLUSIONS Based on this experience, grade I and II intracranial DAVFs may be treated with transarterial Onyx embolization to reduce the shunted blood flow and to facilitate subsequent transvenous embolization or surgery.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing 100050, China.
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Mukerji N, Cahill J, Tzerakis N, Nath FP, Dervin JE. Venous anastomotic circle, multiple varices and oculomotor palsy--a rare coincidence. Acta Neurochir (Wien) 2010; 152:2205-9. [PMID: 20927560 DOI: 10.1007/s00701-010-0819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/23/2010] [Indexed: 11/28/2022]
Abstract
Oculomotor nerve palsy due to a venous varix arising from flow anomalies caused by a dural arteriovenous fistula (AVF) is a rare phenomenon. We report a case of surgical third nerve palsy with a rare underlying AVF as the cause and discuss in detail the patho-anatomy and its significance. A tentorial dural AVF mimicking the arterial circle was found with multiple varix formation causing compressive oculomotor palsy. This was treated successfully with Onyx™ injection with a satisfactory angiographic result and complete resolution of symptoms.
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Affiliation(s)
- Nitin Mukerji
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK.
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Pei W, Huai-Zhang S, Shan-Cai X, Cheng G, Di Z. Isolated hypoglossal nerve palsy due to endovascular treatment of a dural arteriovenous fistula with Onyx-18. Interv Neuroradiol 2010; 16:286-9. [PMID: 20977862 DOI: 10.1177/159101991001600310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 05/02/2010] [Indexed: 10/20/2022] Open
Abstract
We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with Onyx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous embolization may be safer. Furthermore, prednisolone therapy should be carried out in the prophase of nerve palsy.
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Affiliation(s)
- W Pei
- Department of Neurosurgery, The first Affiliated Hospital Harbin Medical University, Harbin Heilongjiang, China
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Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z. Transarterial and transvenous embolization for cavernous sinus dural arteriovenous fistulae. Interv Neuroradiol 2010; 16:269-77. [PMID: 20977859 PMCID: PMC3277999 DOI: 10.1177/159101991001600307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 02/05/2010] [Indexed: 02/05/2023] Open
Abstract
We report on the safety and efficacy of trans-arterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3-42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs.
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Affiliation(s)
- J Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z. Transverse-sigmoid sinus dural arteriovenous fistulae. World Neurosurg 2010; 74:297-305. [PMID: 21492564 DOI: 10.1016/j.wneu.2010.02.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/12/2010] [Indexed: 02/07/2023]
Abstract
Transverse-sigmoid sinus dural arteriovenous fistulae are abnormal arteriovenous communications within the dural wall of the transverse-sigmoid sinuses. They present with a variety of clinical features, ranging from benign bruits to intracranial hemorrhage and neurologic deficits. The presentation and natural history of these fistulae are largely determined by the pattern of venous drainage. Knowledge of natural history and careful study of the angioarchitecture by angiography is therefore mandatory for correct management of these lesions. In this review, anatomy and pathology, principles of management, and the various factors that influence treatment decisions are discussed, with a focus on endovascular therapy. Indications for endovascular treatment, therapeutic goals, approaches, and techniques are reviewed. The role of surgical treatment is also briefly discussed.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach. Eur Radiol 2010; 20:2939-47. [PMID: 20596711 DOI: 10.1007/s00330-010-1857-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/23/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the technique, efficacy, and safety of transvenous embolisation (TVE) of cavernous sinus arteriovenous fistulas (CSDAVFs) via the inferior petrosal sinus (IPS) with detachable coils and acrylic glue. METHODS Spontaneous unilateral CSDAVFs were confirmed by cerebral angiography in eight patients, with angiographic patency of the ipsilateral IPS in three and angiographic non-visualisation of the ipsilateral IPS in five. There were two patients with complete occlusion of the ipsilateral internal jugular vein (IJV). TVE with detachable coils and acrylic glue were performed through a femoral vein and an IPS approach. RESULTS TVE viaipsilateral IPS was successfully performed in all eight patients in our group. The number of detachable coils for each patient ranged from 2 to 8 (mean, 5.0). Angiography immediately after TVE showed complete occlusion of the CSCAVFs in seven patients and nearly complete occlusion in one. Complete recovery of clinical symptoms was achieved in all eight patients. No recurrence of clinical symptoms was observed at follow-up. CONCLUSIONS Transvenous embolisation via an IPS approach is a highly efficient and safe treatment for CSDAVFs. Embolisation with a combination of coils and acrylic glue may help to achieve complete occlusion of fistulas with fewer coils.
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