1
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Cheng HC, Bodani VP, Chung E, Mosimann PJ. Transvenous retrograde pressure cooker technique for embolization of an ethmoidal dural arteriovenous fistula. J Neurointerv Surg 2024; 16:742. [PMID: 37192787 DOI: 10.1136/jnis-2023-020393] [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: 03/30/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
SummaryEthmoidal dural arteriovenous fistulas (DAVFs) are rare lesions, accounting for approximately 10% of intracranial DAVFs.1 2 As ethmoidal DAVFs commonly demonstrate cortical venous drainage, treatment is always warranted.2-6 Endovascular transvenous embolization has been increasingly reported as an effective and safe treatment for ethmoidal DAVFs, and since occlusion of the central retinal artery and resulting blindness are not a concern, it has an advantage over transarterial embolization.3-6 To ensure curative embolization, we adopted the transvenous retrograde pressure cooker technique (RPCT), creating a plug with n-butyl cyanoacrylate (NBCA) in the draining vein to allow a more comprehensive and efficient injection of Onyx (Medtronic, MN) while avoiding excessive reflux.7 8 In this technical video (video 1), we report the first case using the transvenous RPCT for successful Onyx embolization of an ethmoidal DAVF, with emphasis on the technical nuances of the RPCT and important tips to avoid periprocedural complications. neurintsurg;16/7/742/V1F1V1Video 1 Video demonstrating Onyx embolization of an ethmoidal dural arteriovenous fistula using the transvenous retrograde pressure cooker technique.
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Affiliation(s)
- How-Chung Cheng
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Vivek P Bodani
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Emily Chung
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Pascal John Mosimann
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
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2
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Puylaert CAJ, van den Berg R, Coert BA, Emmer BJ. Transarterial Embolization of Anterior Cranial Fossa Dural AVFs as a First-Line Approach: A Single-Center Study. AJNR Am J Neuroradiol 2024; 45:171-175. [PMID: 38176732 DOI: 10.3174/ajnr.a8092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment has been increasingly used for anterior cranial fossa dural AVFs. Evidence on the safety and efficacy of different endovascular treatment strategies is limited. We report clinical and angiographic outcomes of patients with anterior cranial fossa dural AVFs who underwent treatment using transarterial embolization with n-BCA as a first-line approach. MATERIALS AND METHODS Consecutive patients undergoing treatment for anterior cranial fossa dural AVFs at the Amsterdam University Medical Centers between 2010 and 2023 were retrospectively included. Transarterial embolization was used as a first-line approach, while transvenous treatment and surgery were used in cases of unsuccessful transarterial embolization. Treatment was evaluated on the basis of the angiographic cure rate, procedural complications, and clinical outcome. RESULTS Fourteen patients were included with 15 anterior cranial fossa dural AVFs. All patients underwent primary endovascular treatment (12 transarterial, 1 transvenous, and 1 combined). Complete occlusion using only transarterial embolization was reached in 69% of patients (9/13), while the overall complete occlusion by endovascular treatment was reached in 79% of patients (11/14). Navigation and embolization were performed through the ophthalmic artery in 13 patients, with no procedural complications. Visual acuity was preserved in all patients. Three patients underwent an operation after failed endovascular treatment. All patients had complete anterior cranial fossa dural AVF occlusion at follow-up. CONCLUSIONS Treatment of anterior cranial fossa dural AVFs using transarterial embolization with n-BCA as a first-line approach is a safe and feasible first-line treatment strategy. No visual complications due to embolization through the ophthalmic artery occurred in this study.
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Affiliation(s)
- Carl A J Puylaert
- From the Department of Radiology and Nuclear Medicine (C.A.J.P., R.v.d.B., B.J.E.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- From the Department of Radiology and Nuclear Medicine (C.A.J.P., R.v.d.B., B.J.E.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bert A Coert
- Department of Neurosurgery (B.A.C.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bart J Emmer
- From the Department of Radiology and Nuclear Medicine (C.A.J.P., R.v.d.B., B.J.E.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
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3
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Gravino G, Pullicino R, Puthuran M, Edwards Y, Yousaf J, Chavredakis E, Chandran A. Simultaneous bilateral application of the Scepter mini balloon microcatheter for occlusion of ethmoidal dural arteriovenous fistulas. World Neurosurg X 2024; 21:100261. [PMID: 38187506 PMCID: PMC10770548 DOI: 10.1016/j.wnsx.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Ethmoidal dural arteriovenous fistulas are a rare entity accounting for 10 % of all dAVFs.3-6 Haemorrhage occurs in up to 91 % of cases, which is a particularly high risk and warrants therapeutic intervention.8-9 Endovascular treatment for these fistulas using the conventional detachable microcatheter technique is associated with certain limitations and risks; 8.3 % rate of incomplete obliteration and an 8.3 % rate of complications. Complications include reflux of liquid embolic agent, posterior ischaemic optic neuropathy, acute visual loss, and small subdural haematoma secondary to a micro-perforation.8,10-12 We present our recent experience with the Scepter Mini Balloon Microcatheter for the endovascular treatment of ethmoidal dural arteriovenous fistulas in 3 patients, involving bilateral simultaneous inflation of the balloon. It demonstrates a novel application of this technology with good outcomes. It supports the use of this microcatheter in treating ethmoidal dural arteriovenous fistulas endovascularly, either as a first-line option or as an adjunct to surgery.
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Affiliation(s)
- Gilbert Gravino
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Richard Pullicino
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Mani Puthuran
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Ynyr Edwards
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Jawad Yousaf
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Emmanuel Chavredakis
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Arun Chandran
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
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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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Trivelato FP, Smajda S, Saleme S, Castro-Afonso LHD, Abud TG, Ulhôa AC, Blanc R, Abud DG, Mounayer C, Piotin M, Rezende MTS. Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study. J Neurosurg 2022; 137:1758-1765. [PMID: 35395632 DOI: 10.3171/2022.2.jns212588] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angiographic outcomes of patients harboring DAVFs of the anterior cranial fossa who had undergone EVT as a first-line approach. METHODS This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment. RESULTS Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches. CONCLUSIONS Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.
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Affiliation(s)
- Felipe P Trivelato
- 1Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Stanislas Smajda
- 2Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Suzana Saleme
- 3Department of Radiology, Centre Hospitalier et Universitaire Dupuytren, Limoges, France
| | - Luís Henrique de Castro-Afonso
- 4Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
| | - Thiago G Abud
- 4Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
- 5Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Alexandre C Ulhôa
- 1Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Raphael Blanc
- 2Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Daniel G Abud
- 4Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
| | - Charbel Mounayer
- 3Department of Radiology, Centre Hospitalier et Universitaire Dupuytren, Limoges, France
| | - Michel Piotin
- 2Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
| | - Marco Túlio S Rezende
- 1Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
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Matsubara S, Takai H, Enomoto N, Hara K, Hirai S, Sunada Y, Yamada S, Tao Y, Ogawa Y, Yagi K, Uno M. Anterior cranial fossa osseous arteriovenous fistula of the crista galli with bone erosion: patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022. [PMCID: PMC9379729 DOI: 10.3171/case2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Although an anterior cranial fossa dural arteriovenous fistula (ACFdAVF) is thought to have a fistula on the dura near the olfactory groove, the detailed angioarchitecture remains unreported. OBSERVATIONS In case 1, a 65-year-old man was found to have an asymptomatic ACFAVF. His computed tomography angiography (CTA)-maximum intensity projection (MIP) showed the shunt point in the crista galli (CG), with the intradural drainer penetrating the destroyed bone of the CG. In case 2, a 78-year-old man had a past history of intracerebral hemorrhage and was found to have an ACFAVF. The rotational angiography (RA)-MIP showed the intraosseous fistula in the CG with the drainer passing through a tiny bone defect of the CG. In case 3, a 35-year-old man was investigated for epilepsy. The RA-MIP showed an osseous arteriovenous fistula (AVF) in the anterior cranial base, with the drainer penetrating the skull osteolytic site. In case 4, a 73-year-old woman was found to have an asymptomatic ACFAVF. Her RA-MIP showed the osseous AVF with the drainer penetrating the CG with bone erosion. LESSSONS All patients were diagnosed with anterior cranial fossa osseous AVF rather than dAVF, with bone erosion in the CG. These findings should be noted at the time of diagnosis and treatment.
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Affiliation(s)
- Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Noriya Enomoto
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Keijiro Hara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshihiro Sunada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Shodai Yamada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yukari Ogawa
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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7
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Oushy S, Borg N, Lanzino G. Contemporary Management of Cranial Dural Arteriovenous Fistulas. World Neurosurg 2022; 159:288-297. [PMID: 35255630 DOI: 10.1016/j.wneu.2021.09.045] [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: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
Cranial dural arteriovenous fistulas (dAVFs) are rare acquired neurovascular disorders that have the potential to profoundly alter the local and global cerebral venous drainage. Factors such as location, angioarchitecture, degree of shunting, and mode of presentation all appear to have some bearing on the natural history of dAVFs, which can vary from almost entirely benign to life-threatening. Accurate and evidence-based risk stratification is, therefore, key to informing important management decisions. The treatment strategies are nuanced and, for an already rare entity, can vary tremendously from 1 fistula to another. It is only through a thorough understanding of their behavior and the treatment options available that we will be able to deliver tailored treatment to the correct dAVF and the correct patient. We aimed to provide an up-to-date summary of the reported data on the natural history and predictors of aggressive behavior for cranial dAVFs in general, followed by site-specific management considerations.
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Affiliation(s)
- Soliman Oushy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Borg
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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8
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Salvati LF, Palmieri G, Minardi M, Bianconi A, Melcarne A, Garbossa D. Foramen Caecum Vein Involved in Dural Arteriovenous Fistula Fed by Sphenopalatine Arteries: A Case Report. NMC Case Rep J 2022; 8:371-376. [PMID: 35079491 PMCID: PMC8769432 DOI: 10.2176/nmccrj.cr.2020-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022] Open
Abstract
Anterior cranial fossa (ACF) dural arteriovenous fistulas (ACF DAVFs) are an infrequent subtype of cranial DAVFs that are usually fed by the anterior ethmoidal artery (AEA) and ophthalmic artery (OA) branches. Due to the lack of dural venous sinus in the ACF, they directly drain into cortical veins, resulting in high bleeding tendency. For this reason, ACF DAVFs have to be treated regardless of whether they are symptomatic or not. A 74-year-old man, with hypertension history, came to our attention because of ear pain, dizziness, and impaired hearing for 2 months. No other pathological conditions have been found in his medical history. The patient underwent brain magnetic resonance imaging (MRI) scan and subsequently second level diagnostic investigations with digital subtraction angiography (DSA), showing a foramen caecum (FC) patency and a persistent, enlarged, arterialized FC vein (FCV) involved in an incidental ACF DAVF (Cognard IV), fed mainly by sphenopalatine arteries (SPAs) branches bilaterally. The patient underwent open surgery performed by small high frontal craniotomy with DAVFs complete closure and without any complications. To the best of our knowledge, this is the first case ever described of FCV persistence with involvement in an intracranial vascular malformation. It has been managed by surgical intervention that can be considered, despite the large skin incision, a minimally invasive approach with an excellent cosmetic result and minimal risk of complications.
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Affiliation(s)
- Luca Francesco Salvati
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
| | - Giuseppe Palmieri
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
| | - Massimiliano Minardi
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
| | - Andrea Bianconi
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
| | - Antonio Melcarne
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
| | - Diego Garbossa
- Division of Neurosurgery, Department of Neurosciences "Rita Levi Montalcini", City of Health and Science and University of Turin, Turin, Italy
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Kwon MY, Kwon SM, Kim CH, Lee CY. Transarterial embolization through the infraorbital artery of the ethmoidal dural arteriovenous fistula causing recurrent epistaxis: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2123. [PMID: 35855220 PMCID: PMC9245782 DOI: 10.3171/case2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND This report describes an ethmoidal dural arteriovenous fistula (DAVF) presenting with the unusual symptom of recurrent epistaxis and successfully treated with selective transarterial embolization through the infraorbital artery (IOA), which is the first time this route was used to the best of the authors’ knowledge, and reviews the literature focusing on the anatomical consideration of ethmoidal DAVFs causing epistaxis and its treatment approaches. OBSERVATIONS A 70-year-old man experienced recurrent intractable epistaxis that bled like a faucet turned on. Cerebral angiography revealed an ethmoidal DAVF supplied by the left anterior ethmoidal artery, both sphenopalatine arteries, both IOAs, and the right angular artery, which drained directly into the frontal cortical veins with a tortuous arterialized ectasia. Microaneurysms around the fistulous location where multiple feeding arteries converge were demonstrated and considered the likely source of the epistaxis. The fistula was completely occluded using transarterial Onyx embolization through the IOA, a branch of the internal maxillary artery. No further epistaxis appeared. LESSONS Although extremely rare, ethmoidal DAVFs should be included in the differential diagnosis of recurrent epistaxis. Ethmoidal DAVFs with bleeding sources in the ethmoid sinus and nasal cavity may cause epistaxis. It is important to properly diagnose and treat ethmoidal DAVFs presenting with epistaxis on the basis of a comprehensive anatomical understanding of extensive extracranial-extracranial and extracranial-intracranial anastomoses.
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10
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Mohanty A, Kan P. Commentary: Transpalpebral Incision for Resection of an Ethmoidal Dural Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E607-E608. [PMID: 32862233 DOI: 10.1093/ons/opaa253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/21/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alina Mohanty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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11
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Anterior Cranial Fossa Dural Arteriovenous Fistulae - Angioarchitecture and Intervention. Clin Neuroradiol 2020; 31:661-669. [PMID: 32666243 DOI: 10.1007/s00062-020-00932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVF) are rare, unique, and ominous. While surgical disconnection is considered as the favored management option, endovascular treatment has lately gained importance. We present a single institution experience of seven cases. METHOD A retrospective analysis was performed on the institutional patient database. Features analyzed were demographic details, symptoms, angioarchitecture, treatment course, angiographic results, procedural complications, and follow-up. RESULTS This study included seven patients. The age at presentation ranged from 5-67 years. Clinical symptomatology was as intracranial hemorrhage in 4 patients and headache, chemosis and seizures in one patient each. The fistulae were paramedian at the ACF base. All DAVFs were Cognard type 4. The arterial feeders were from the anterior ethmoidal branches of the ophthalmic artery in all cases (bilateral in n = 5), frontal branches of the middle meningeal artery (MMA) (n = 6), and multiple ECA branches. The arterial route was the choice for access. Complete fistula obliteration was achieved in all but one patient. A traversed vein underwent rupture in one patient. One patient suffered postsurgical hemorrhage. No clinical or angiographic recurrence was noted. CONCLUSION The DAVFs of the ACF are inherently high-grade lesions. Transorbital ECA-ICA branch anastomoses may be recruited as feeders. They may be best managed by multidisciplinary means personalized on an angioarchitectural basis. Endovascular embolization is safe and efficacious when performed through a navigable feeder from the frontal division of the MMA, which according to our interpretation is in anastomosis with the anterior falcine branch of the anterior ethmoidal artery.
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Padilha IG, Pacheco FT, Araujo AIR, Nunes RH, Baccin CE, Conti MLM, Maia ACM, Rocha AJD. Tips and tricks in the diagnosis of intracranial dural arteriovenous fistulas: A pictorial review. J Neuroradiol 2019; 47:369-381. [PMID: 31279838 DOI: 10.1016/j.neurad.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/25/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) are complex vascular abnormalities that account for 10-15% of intracranial vascular malformations. DAVFs are typically encountered in middle-aged adults, with a slightly female predominance. The causative factors are still uncertain; however, abnormal local hemodynamics and neoangiogenesis related to dural sinus or venous thrombosis can contribute to DAVF occurrence. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging techniques. Computed tomography and/or magnetic resonance imaging aid in the diagnosis, but conventional angiography remains the most accurate method for the complete characterization and classification of DAVFs. The therapeutic approach can be conservative or more aggressive, based on symptom severity, sequelae risk and patient characteristics. This article is a pictorial review of adult intracranial DAVFs that highlights some tips and tricks for recognizing useful red flags in the suspicion of DAVFs.
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Affiliation(s)
- Igor Gomes Padilha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil.
| | - Felipe Torres Pacheco
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Alan Iuno Rios Araujo
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Renato Hoffmann Nunes
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Carlos Eduardo Baccin
- Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, 05652-900 Sao Paulo SP, Brazil
| | - Mario Luiz Marques Conti
- Division of Interventional Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil
| | - Antônio Carlos Martins Maia
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Fleury Medicina e Saúde, Rua Cincinato Braga, 282 - Bela Vista, 01333-910 Sao Paulo SP, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
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13
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Piergallini L, Tardieu M, Cagnazzo F, Gascou G, Dargazanli C, Derraz I, Costalat V, Bonafé A, Lefevre PH. Anterior cranial fossa dural arteriovenous fistula: Transarterial embolization from the ophthalmic artery as first-line treatment. J Neuroradiol 2019; 48:207-214. [PMID: 31229577 DOI: 10.1016/j.neurad.2019.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To retrospectively review the outcome of patients with dural arteriovenous fistula of the anterior cranial fossa (afDAVF) treated by transarterial embolization. MATERIAL AND METHODS Six consecutive patients were referred to our hospital for afDAVF treatment. After a multidisciplinary discussion, they underwent endovascular embolization with Onyx injection through the ophthalmic artery. Their clinical presentation, management and outcomes were retrospectively assessed. RESULTS All interventions were performed with the liquid embolic agent Onyx through the transarterial route from the ophthalmic artery to access the fistulous point. All patients showed a good outcome with complete afDAVF obliteration. CONCLUSION This study demonstrates that afDAVFs can be safely and completely obliterated by transarterial embolization via the ophthalmic artery.
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Affiliation(s)
- Lorenzo Piergallini
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France; Postgraduation School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Maxime Tardieu
- Department of Radiology, Perpignan Hospital, Perpignan, France
| | - Federico Cagnazzo
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Grégory Gascou
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Cyril Dargazanli
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Imad Derraz
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Vincent Costalat
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Alain Bonafé
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France.
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14
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Giannopoulos S, Texakalidis P, Mohammad Alkhataybeh RA, Charisis N, Rangel-Castilla L, Jabbour P, Grossberg JA, Machinis T. Treatment of Ethmoidal Dural Arteriovenous Fistulas: A Meta-analysis Comparing Endovascular versus Surgical Treatment. World Neurosurg 2019; 128:593-599.e1. [PMID: 31059849 DOI: 10.1016/j.wneu.2019.04.227] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) in the anterior cranial fossa constitute approximately 1%-1.5% of intracranial vascular malformations. Depending on the drainage patterns, the diagnosis of ethmoidal DAVFs should prompt treatment because of the high risk of bleeding. Available treatments strategies are surgical treatment and the endovascular approach. OBJECTIVE To compare the surgical treatment with the endovascular therapy in terms of complete obliteration and perioperative adverse events. METHODS This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed and Cochrane until February 2019. A random effects model meta-analysis of odds ratios (OR) was conducted and the I-square was used to assess heterogeneity. Good outcome was defined as no neurologic deterioration within 30 days after the procedure. RESULTS Five studies comprising 81 patients were included in the meta-analysis. Surgical disconnection was superior to endovascular therapy in terms of postprocedural complete obliteration rate (surgery group, 100% [n = 65/65]; endovascular therapy, 47% [n = 15/32]; OR, 32.19; 95% confidence interval, 5.46-189.72; I2 = 9.9%) and 30-day good outcome (surgery group, 98% [n = 63/64]; endovascular therapy, 47% [n = 15/32]; OR, 21.90; 95% confidence interval, 1.94-247.27; I2 = 53.6%). No significant differences in terms of 30-day stroke, transient ischemic attack; visual deficit, new-onset seizure, and intracranial hemorrhage were identified. CONCLUSIONS Surgical treatment was superior to endovascular therapy in terms of complete obliteration and overall good outcome. Adverse event rates were similar between the 2 groups. Future studies should be conducted to validate our results.
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Affiliation(s)
| | - Pavlos Texakalidis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nektarios Charisis
- Department of Surgery, Division of Surgical Oncology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theofilos Machinis
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
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15
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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: 24] [Impact Index Per Article: 4.8] [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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