1
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Robledo A, Frank TS, Karas PJ, Shaltoni H, O'Leary S, Darling R, Kan P. Stereotactic-guided direct orbital puncture for treatment of orbital arteriovenous fistula. J Neurointerv Surg 2024; 16:429. [PMID: 37142395 DOI: 10.1136/jnis-2023-020145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
The patient presented with left-sided chemosis, exophthalmos, and progressive visual loss. Cerebral angiography ed a left orbital arteriovenous malformation and an associated hematoma, with the point of fistulation between the left ophthalmic artery and the anterior section of the inferior ophthalmic vein, with retrograde flow through the superior ophthalmic vein. Transvenous embolization through the anterior facial and angular veins was unsuccessful, with residual shunting. Stereotactic-guided direct venous puncture and Onyx embolization was subsequently performed in the hybrid operating room (OR) to cure the fistula. A subciliary incision allowed for retraction of the orbital contents, creating an optimal trajectory. An endonasal endoscopic approach was performed after the embolization to decompress the orbit. This procedure is shown in video 11-11 neurintsurg;16/4/429/V1F1V1Video 1 .
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Affiliation(s)
- Ariadna Robledo
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Thomas S Frank
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Patrick J Karas
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Hashem Shaltoni
- Neurology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Sean O'Leary
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Robert Darling
- Otolaryngology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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2
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Hong Z, Noonan JE, Mitchell PJ, Hardy TG. Peripheral Ophthalmic Artery Aneurysm Associated with Multifocal Intracranial and Extracranial Aneurysms: Case Report and Literature Review. Case Rep Ophthalmol 2023; 14:257-266. [PMID: 37383172 PMCID: PMC10294283 DOI: 10.1159/000530475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 06/30/2023] Open
Abstract
Peripheral ophthalmic artery aneurysm is a rare disease entity. We review the relevant literature and report a case of fusiform aneurysm involving the entire intraorbital ophthalmic artery in association with multiple intracranial and extracranial aneurysms, diagnosed on digital subtraction angiography. The patient suffered irreversible blindness secondary to compressive optic neuropathy which did not improve after a 3-day trial of intravenous methylprednisolone. Autoimmune screen was normal. The underlying cause is unknown.
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Affiliation(s)
- Zixin Hong
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan E. Noonan
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Peter J. Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas G. Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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3
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Abecassis IJ, Meyer RM, Levitt MR, Sheehan JP, Chen CJ, Gross BA, Lockerman A, Fox WC, Brinjikji W, Lanzino G, Starke RM, Chen SH, Potgieser ARE, van Dijk JMC, Durnford A, Bulters D, Satomi J, Tada Y, Kwasnicki A, Amin-Hanjani S, Alaraj A, Samaniego EA, Hayakawa M, Derdeyn CP, Winkler E, Abla A, Lai PMR, Du R, Guniganti R, Kansagra AP, Zipfel GJ, Kim LJ. Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation. J Neurosurg 2021; 136:971-980. [PMID: 34507300 DOI: 10.3171/2021.1.jns202861] [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: 07/24/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.
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Affiliation(s)
| | | | - Michael R Levitt
- Departments of1Neurological Surgery.,4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Jason P Sheehan
- 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ching-Jen Chen
- 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Bradley A Gross
- 6Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ashley Lockerman
- 7Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - W Christopher Fox
- 7Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Waleed Brinjikji
- Departments of8Neurosurgery and.,9Radiology, Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- Departments of8Neurosurgery and.,9Radiology, Mayo Clinic, Rochester, Minnesota
| | - Robert M Starke
- 10Department of Neurological Surgery, University of Miami, Florida
| | - Stephanie H Chen
- 10Department of Neurological Surgery, University of Miami, Florida
| | - Adriaan R E Potgieser
- 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - J Marc C van Dijk
- 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Andrew Durnford
- 12Department of Neurosurgery, University of Southampton, United Kingdom
| | - Diederik Bulters
- 12Department of Neurosurgery, University of Southampton, United Kingdom
| | - Junichiro Satomi
- 13Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- 13Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Amanda Kwasnicki
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | | | - Ali Alaraj
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Edgar A Samaniego
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minako Hayakawa
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Colin P Derdeyn
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ethan Winkler
- 16Department of Neurological Surgery, University of California, San Francisco, California
| | - Adib Abla
- 16Department of Neurological Surgery, University of California, San Francisco, California
| | - Pui Man Rosalind Lai
- 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Rose Du
- 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | | | - Akash P Kansagra
- Departments of18Neurological Surgery.,20Neurology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Louis J Kim
- Departments of1Neurological Surgery.,2Radiology, and.,4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
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4
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Kuroda H, Takagaki M, Ryuichi H, Yuichi M, Nishida T, Nakamura H, Kishima H. A case of meningolacrimal artery aneurysm associated with meningioma. Surg Neurol Int 2021; 12:61. [PMID: 33654564 PMCID: PMC7911222 DOI: 10.25259/sni_811_2020] [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: 11/13/2020] [Accepted: 01/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background Intraorbital aneurysms are rare, and most of them originate from the ophthalmic arteries. Herein, we report a case of meningolacrimal artery aneurysm associated with a meningioma. Case Description A 55-year-old woman had a frontal convexity meningioma identified by brain magnetic resonance imaging during a checkup. Cerebral angiography revealed the middle meningeal artery as a feeding artery as well as the presence of an aneurysm associated with the meningolacrimal artery. Embolization of the feeding artery was performed before the removal of the meningioma. The meningioma was resected, and the aneurysm was removed with a bone flap. The patient was discharged without any complications. Conclusion We report a meningolacrimal artery aneurysm associated with a meningioma. Embolizing the feeding artery of the aneurysm was helpful in safely resecting the meningioma.
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Affiliation(s)
- Hideki Kuroda
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masatoshi Takagaki
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirayama Ryuichi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Matsui Yuichi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeo Nishida
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
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5
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Combined Surgical and Endovascular Treatment of an Intraorbital Arteriovenous Fistula Drained Into a Basal Vein of Rosenthal: A Technical Case Report. World Neurosurg 2020; 141:15-19. [PMID: 32479909 DOI: 10.1016/j.wneu.2020.05.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intraorbital arteriovenous fistulas (AVFs) are rare lesions, and their treatment is challenging. We have presented a case of an intraorbital AVF treated with endovascular embolization through the surgically accessed basal vein of Rosenthal. CASE DESCRIPTION A 53-year-old man had been referred to our hospital for an aneurysm-like lesion that was compressing the left optic chiasm. A left internal carotid angiogram demonstrated an orbital AVF fed by a distal segment of the ophthalmic arteries and the anterior branch of the inferolateral trunk that was drained solely into a tortuous basal vein of Rosenthal through a bridging vein of the left optic nerve sheath. Considering the risk of hemorrhagic complications during transvenous manipulation and visual complication in cases of transarterial embolization, combined surgical and transvenous embolization was attempted through the translocated basal vein of Rosenthal to bypass the dangerous path to the fistula. The lesion was directly catheterized through the translocated basal vein of Rosenthal after confirming visual tolerance to brief drainage occlusion using visual evoked potential monitoring, resulting in successful fistula obliteration using detachable coils. CONCLUSION Direct catheterization of the translocated deep draining vein was useful to bypass the dangerous access to the fistula and could be a feasible alternative strategy for treating selected AVFs.
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6
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Hiramatsu M, Sugiu K, Haruma J, Hishikawa T, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Date I. Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:593-604. [PMID: 37502140 PMCID: PMC10370661 DOI: 10.5797/jnet.ra.2020-0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/08/2020] [Indexed: 07/29/2023]
Abstract
Besides cavernous sinus (CS) dural arteriovenous fistulas (AVFs), AVF may develop around the parasellar region. They can cause various symptoms, and some of them may show similar symptoms to those of CS dural AVF. Therefore, these AVFs may be misdiagnosed as CS dural AVFs. In this review, we divided parasellar AVFs into four groups based on their locations related to the CS: anterior group (orbit), anterolateral group (sphenoid wing), posteroinferior group (inferior petrosal sinus and clivus), and posterior group (superior petrosal sinus and petrosal vein). Although parasellar AVFs share common points, there are many differences between the four groups. We herein discuss commonalities and differences in parasellar AVFs based on a review of the literature and our experience.
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Affiliation(s)
- Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Jun Haruma
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yu Takahashi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kazuhiko Nishi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yoko Yamaoka
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
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7
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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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8
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Garala P, Virdee J, Qureshi M, Gillow T. Intraorbital aneurysm of the ophthalmic artery. BMJ Case Rep 2019; 12:12/4/e227044. [PMID: 31015236 DOI: 10.1136/bcr-2018-227044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intraorbital ophthalmic artery (OA) aneurysms are rare. They can be asymptomatic or present with visual disturbances, exophthalmos and headaches. We present a case of a 57-year-old man who presented with reduced vision, diplopia and exophthalmos. A carotid artery angiogram identified a right OA aneurysm. Due to the low risk of rupture and the patient's comorbidities including cardiac and renal impairment, a conservative approach was followed. A few weeks post presentation, the patient's vision and optic nerve function had improved. This case reiterates the importance of considering conservative treatment for patients with intraorbital OA aneurysms.
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Affiliation(s)
- Pavitra Garala
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jasvir Virdee
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Madyan Qureshi
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Timothy Gillow
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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9
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Martínez-Pérez R, Tsimpas A, Ruiz Á, Montivero A, Mura J. Spontaneous Regression of a True Intracanalicular Fusiform Ophthalmic Artery Aneurysm After Endovascular Treatment of an Associated Dural Arteriovenous Fistula. World Neurosurg 2018; 119:362-365. [PMID: 30114538 DOI: 10.1016/j.wneu.2018.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ophthalmic trunk aneurysms associated with other vascular malformations are extremely rare, and little is known regarding its natural history and options of treatment. CASE DESCRIPTION We present the interesting case of a 51-year-old man who was admitted with progressive visual loss secondary to a concurrent fusiform ophthalmic trunk aneurysm associated with a dural arteriovenous fistula. He was treated with transarterial embolization of the fistulous point. CONCLUSIONS A follow-up angiogram at 6 months showed complete obliteration of the dural arteriovenous fistula and regression of the ophthalmic trunk aneurysm. The literature is reviewed, and potential pathophysiologic mechanisms leading to this association and regression in this subgroup of aneurysms are discussed.
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Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurosurgery, National Institute of Neurosurgical Sciences Dr Asenjo, University of Chile, Santiago, Chile; Department of Neurosurgery, Universidad Complutense, Madrid, Spain.
| | - Asterios Tsimpas
- Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Álvaro Ruiz
- Department of Neurosurgery, National Institute of Neurosurgical Sciences Dr Asenjo, University of Chile, Santiago, Chile
| | - Agustin Montivero
- Department of Neurosurgery, National Institute of Neurosurgical Sciences Dr Asenjo, University of Chile, Santiago, Chile
| | - Jorge Mura
- Department of Neurosurgery, National Institute of Neurosurgical Sciences Dr Asenjo, University of Chile, Santiago, Chile
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10
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Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review. Neurosurg Rev 2017; 42:277-285. [PMID: 29177821 DOI: 10.1007/s10143-017-0929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/21/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
Arterial aneurysms are uncommon among patients with dural arteriovenous fistulae (DAVFs), and there is limited information available to guide treatment decisions in such cases. We performed a systematic review of the literature, including a case of a DAVF associated with a flow-related intraorbital ophthalmic artery (OA) aneurysm that we have recently managed. The purpose of our study was to clarify epidemiology, natural history, and management of these lesions. A total of 43 published cases of DAVF associated aneurysms were found in 26 studies on the topic. Anterior cranial fossa was the most common location (40%), and ethmoidal branches were the most common arterial feeders (55%). In about 63% of cases, the aneurysm was located on artery unrelated to DAVF supply. Approximately 10% of intracranial DAVFs were associated with aneurysms located in the intraorbital OA. Overall, 70% of lesions were Borden type III, and 50% of patients presented with hemorrhage. In approximately 17% of cases, the source of bleeding was a feeding artery aneurysm. All of the reported intraorbital OA aneurysms associated with DAVFs remained stable during follow-up. DAVF associated aneurysms are fairly rare. Anterior cranial fossa location and direct cortical venous drainage are common among these lesions. The aneurysms are less likely to be located on feeding arteries, and hemorrhagic presentation related to flow-related aneurysm rupture is uncommon.
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11
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Lv X, Li W, Liu A, Lv M, Jiang C. Endovascular treatment evolution for pure intraorbital arteriovenous fistula: Three case reports and literature review. Neuroradiol J 2017; 30:151-159. [PMID: 28424011 PMCID: PMC5433595 DOI: 10.1177/1971400917692163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and importance Intraorbital arteriovenous fistulas (IOAVFs) are rare and cause eye redness, exophthalmos, blurry vision and bruit. Whereas in the past they were treated conservatively, surgically or transarterially, recent developments in transvenous embolization have improved their treatment. In this paper the authors report three cases of IOAVFs treated endovascularly and review the evolution of treatment options. Methods Three cases of purely IOAVF enrolled in our center were reported and a PubMed literature search was performed using "pure intraorbital arteriovenous fistula" and "arteriovenous fistula of the optic nerve sheath." A total of 21 papers were reviewed in full, focusing primarily on the treatment and outcomes. Results A total of 26 patients were obtained, including our three patients and 23 patients reported in the literature. In nine patients treated conservatively, four spontaneous occlusions, one visual deterioration and four cases with unknown outcome were reported. In another 18 patients, 29 therapies (including five surgical treatment, 11 transarterial embolizations and 13 transvenous embolizations) were attempted and resulted in 12 cures, five visual deteriorations and one without reported outcome. More recently, transvenous embolization has become the mainstay of IOAVF treatment. Of the 21 patients assessed between 2000 and 2013, a transvenous approach was attempted in 13 patients; nine patients were cured without any adverse events. Conclusion Development and improvement of transvenous techniques are found to be safe and effective for patients with IOAVF.
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Affiliation(s)
- Xianli Lv
- Xianli Lv, Beijing Neurosurgical Institute, No. 6, Tiantan Xili, Chongwen, Beijing, 100050 P.R. China.
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12
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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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