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Su X, Shang Z, Li X, Song Z, Ye M, Sun L, Hong T, Ma Y, Zhang H, Zhang P. Dural arteriovenous fistulas in the falx cerebri: case series and literature review. Neurosurg Rev 2024; 47:303. [PMID: 38954153 DOI: 10.1007/s10143-024-02544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
Dural arteriovenous fistulas (DAVFs) within the falx cerebri are infrequently documented and may be linked with the falcine sinus/venous plexus. The falcine sinus/venous plexus, often regarded as a normal venous structure, can exhibit pathological characteristics, differing from the persistent fetal falcine sinus. A retrospective analysis was conducted at a single center to identify all cases of DAVFs within the falx cerebri spanning from 2002 to 2022. Demographic data, fistula features, treatment modalities, clinical outcomes, and fistula closure were collected and analyzed. Additionally, relevant literature on DAVFs in this location was reviewed. Ten cases were identified at our center, supplemented by 13 cases reported in the literature. In our cohort, patients had an average age of 49.4 ± 8.1 years, with a male predominance of 90%. Trans-arterial embolization (TAE) alone achieved immediate complete occlusion in eight cases, while conservative treatment was pursued in two cases. No treatment-related complications or fistula recurrences were observed. In the literature, seven patients underwent direct surgery, three underwent TAE, and one underwent both direct surgery and radiosurgery for complete fistula closure. No instances of fistula recurrence or treatment complications were reported. Dural arteriovenous fistulas within the falx cerebri are rare, with limited literature available. They typically present as aggressive lesions. Treatment options include direct surgery or TAE. However, due to a lack of long-term DSA follow-up, the cure and recurrence rates are unknown for endovasdcular therapy. Further investigation is warranted to elucidate the involvement of the falcine sinus/venous plexus in falx cerebri DAVFs.
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Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiyuan Shang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Department of Neurosurgery, Beijing Fengtai You'anmen Hospital, Beijing, 100069, China
| | - Xiangyu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- , No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Yoshioka S, Moroi J, Kobayashi S, Furuya N, Ishikawa T. A case of falcine sinus dural arteriovenous fistula. Neurosurgery 2013; 73:E554-6. [PMID: 23632767 DOI: 10.1227/01.neu.0000430325.02645.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE The falcine sinus is an embryonic vessel that connects the superior and inferior sagittal sinuses and mostly closes after birth. Although some cases of persistent falcine sinus have been reported, dural arteriovenous fistula (dAVF) associated with the falcine sinus has not previously been reported. CLINICAL PRESENTATION A 60-year-old man presented with asymptomatic dAVFs on digital subtraction angiography. The dAVFs were fed mainly by the cortical branch of the left anterior cerebral artery and drained into the falcine sinus. Intraoperatively, all veins draining in a retrograde manner into cortical veins were obstructed. However, cortical venous reflux did not disappear before removal of the falx cerebri, including the falcine sinus and inferior sagittal sinus. In this case, we considered falcine sinus dAVF as equivalent to olfactory groove dAVF because the medial olfactory artery, in its role as a common feeding artery in olfactory groove dAVF, is a rudiment of the anterior cerebral artery as the main feeding artery in this case. Intraoperative findings and the surgical specimen revealed a small vessel network in the falx cerebri communicating with the falcine and inferior sagittal sinuses, which was considered to represent a falcine venous plexus, not a vessel anomaly. CONCLUSION Extensive removal of the falx cerebri including the falcine sinus or complete endovascular obliteration of the whole falcine sinus as early as possible represents an important strategy in the surgical treatment of falcine sinus dAVF.
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Affiliation(s)
- Shotaro Yoshioka
- Department of Neurosurgery, Research Institute for Brain and Blood Vessels, Akita, Japan.
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