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Yang Z, Gao Y, Liu T, Li C, Huang J, Xie T, Yang L, Zhao P, Zhang X. Purely Endoscopic Keyhole Approach for Resection of a Frontal Falx Dural Arteriovenous Fistula: A Technical Note. World Neurosurg 2022; 166:228-236.e1. [PMID: 35948222 DOI: 10.1016/j.wneu.2022.07.143] [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: 07/09/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Dural arteriovenous fistulas (DAVFs) in the falx cerebri are rare. This study presents a case of DAVF in the frontal falx cerebri that was successfully resected using a purely endoscopic keyhole microsurgical technique. METHODS A 69-year-old male patient presented to the emergency department with an acute onset seizure. His condition was diagnosed as a DAVF in the frontal falx cerebri with multiple fistula points. A purely endoscopic resection was performed under neuronavigation. Postoperative angiography and clinical follow-up were performed after 10 days and 3 months, respectively. RESULTS The DAVF was satisfactorily observed and resected using a purely endoscopic keyhole microsurgical technique, with no deterioration of neural functions or major vessel ruptures. Postoperative angiogram revealed complete obliteration of the DAVF and no recurrent epilepsy during the clinical follow-up. CONCLUSIONS Supported by sufficient preoperative evaluation and meticulous manipulation,a purely endoscopic minimally invasive resection is feasible and safe for DAVF, with the advantages of close observation and panoramic view.
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Affiliation(s)
- Zhigang Yang
- National Clinic Research Center for Interventional Medicine, Shanghai, China; Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Gao
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tengfei Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangliang Yang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Puyuan Zhao
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Korai M, Enomoto N, Satoh K, Matsubara S, Kanematsu Y, Yamaguchi T, Hanaoka M, Niki H, Matsuzaki K, Bando K, Hagino H, Takagi Y. Transarterial embolization for convexity dural arteriovenous fistula with or without pial arterial supply: A report of four patients. Surg Neurol Int 2022; 13:340. [PMID: 36128114 PMCID: PMC9479601 DOI: 10.25259/sni_215_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Convexity dural arteriovenous fistulae (dAVF) usually reflux into cortical veins without involving the venous sinuses. Although direct drainage ligation is curative, transarterial embolization (TAE) may be an alternative treatment. Case Description: Between September 2018 and January 2021, we encountered four patients with convexity dAVFs. They were three males and one female; their age ranged from 36 to 73 years. The initial symptom was headache (n = 1) or seizure (n = 2); one patient was asymptomatic. In all patients, the feeders were external carotid arteries with drainage into the cortical veins; in two patients, there was pial arterial supply from the middle cerebral artery. All patients were successfully treated by TAE alone using either Onyx or N-butyl cyanoacrylate embolization. Two patients required two sessions. All dAVFs were completely occluded and follow-up MRI or angiograms confirmed no recurrence. Conclusion: Our small series suggests that TAE with a liquid embolic material is an appropriate first-line treatment in patients with convexity dAVFs with or without pial arterial supply.
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Affiliation(s)
- Masaaki Korai
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Noriya Enomoto
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Koichi Satoh
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama,
| | | | - Tadashi Yamaguchi
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Mami Hanaoka
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Hitoshi Niki
- Department of Neurology, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Kazuhito Matsuzaki
- Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima,
| | - Koji Bando
- Department of Neurosurgery, Tokushima University, Tokushima,
| | - Hirotaka Hagino
- Department of Neurosurgery, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima,
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Current concepts and perspectives on brain arteriovenous malformations: A review of pathogenesis and multidisciplinary treatment. World Neurosurg 2021; 159:314-326. [PMID: 34339893 DOI: 10.1016/j.wneu.2021.07.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are unusual vascular pathologies characterized by the abnormal aggregation of dilated arteries and veins in the brain parenchyma and for which the absence of a normal vascular structure and capillary bed leads to direct connections between arteries and veins. Although bAVMs have long been believed to be congenital anomalies that develop during the prenatal period, current studies show that inflammation is associated with AVM genesis, growth, and rupture. Interventional treatment options include microsurgery, stereotactic radiosurgery, and endovascular embolization, and management often comprises a multidisciplinary combination of these modalities. The appropriate selection of patients with brain arteriovenous malformations for interventional treatment requires balancing the risk of treatment complications against the risk of hemorrhaging during the natural course of the pathology; however, no definitive guidelines have been established for the management of brain arteriovenous malformations. In this paper, we comprehensively review the current basic and clinical studies on bAVMs and discuss the contemporary status of multidisciplinary management of bAVMs.
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