1
|
Détraz L, Orlov K, Berestov V, Borodetsky V, Rouchaud A, de Abreu Mattos LG, Mounayer C. Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment. AJNR Am J Neuroradiol 2019; 40:1363-1368. [PMID: 31371356 DOI: 10.3174/ajnr.a6140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dural AVFs located in the posterior fossa are a rare entity. The objectives of the study were to analyze the anatomy of dural AVFs, their endovascular treatment strategies, and clinical outcomes. MATERIALS AND METHODS Two centers retrospectively selected patients treated between January 2009 and June 2018 having posterior fossa dural AVFs. We collected patient demographics, clinical presentation, arterial and venous outflow anatomy of the dural AVFs, and treatment outcomes. RESULTS Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs (88.5%); a combined transarterial and transvenous approach, for 2 dural AVFs (7.7%); and a transvenous approach alone, for 1 dural AVF (3.8%). The middle meningeal artery was the most common artery chosen to inject embolic liquid (46%, 12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%. CONCLUSIONS Endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates. The arterial approach is the first-line preferred approach, even if a transvenous or combined approach would be a safe and effective option for patients with favorable anatomy.
Collapse
Affiliation(s)
- L Détraz
- From the Service de Neuroradiologie Interventionnelle et Diagnostique (L.D.), Centre Hospitalier Universitaire de Nantes-Hopital Laennec, Saint-Herblain, France
| | - K Orlov
- Department of Neurosurgery (K.O., V. Berestov), E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - V Berestov
- Department of Neurosurgery (K.O., V. Berestov), E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - V Borodetsky
- Service de Radiologie (V. Borodetsky, A.R.. L.G.d.A.M., C.M.), Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - A Rouchaud
- Service de Radiologie (V. Borodetsky, A.R.. L.G.d.A.M., C.M.), Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire de Limoges, Limoges, France.,CNRS (A.R., C.M.), XLIM, UMR 7252, University of Limoges, Limoges, France
| | - L G de Abreu Mattos
- Service de Radiologie (V. Borodetsky, A.R.. L.G.d.A.M., C.M.), Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - C Mounayer
- Service de Radiologie (V. Borodetsky, A.R.. L.G.d.A.M., C.M.), Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire de Limoges, Limoges, France.,CNRS (A.R., C.M.), XLIM, UMR 7252, University of Limoges, Limoges, France
| |
Collapse
|
2
|
Dinc N, Won SY, Eibach M, Quick-Weller J, Keil F, Berkefeld J, Konczalla J, Marquardt G, Seifert V. Thrombosis of the straight sinus and microbleedings due to deep seated arteriovenous fistula - Hemodynamic changes, cognitive impairment and improvement after microsurgery. A technical report. J Clin Neurosci 2019; 68:317-321. [PMID: 31324470 DOI: 10.1016/j.jocn.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/09/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Dural arteriovenous fistulas (dAVF) are rare vascular malformations accounting for only 10-15% that may lead to life threatening deficits due to hemodynamic changes in blood supply and pressure conditions. We present a 64-year old patient who was admitted with disorientation and aphasia. Following images confirmed an infratentorial dural fistula draining into the straight sinus. Additional findings were progressive thrombosis of the straight sinus, microbleedings and bithalamic edema due changes in hemodynamic conditions and venous congestion. Microsurgery was performed. After treatment improvement in clinical condition was observed and the venous congestion was regressive. Hemodynamic changes due to infratentorial dAVFs may lead to bleedings in deep regions and worsening of clinical condition fastly. Treatment requires carefully planning and visualization of angioarchitecture. Symptoms and hemodynamic changes are reversible after treatment, which are essential for treatment decisions.
Collapse
Affiliation(s)
- Nazife Dinc
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Michael Eibach
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | | | - Fee Keil
- Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Joachim Berkefeld
- Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| |
Collapse
|
3
|
Pierot L. [Place of interventional neuroradiology in the prevention of hemorrhagic stroke]. Presse Med 2019; 48:672-683. [PMID: 31153681 DOI: 10.1016/j.lpm.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The risk of bleeding of unruptured aneurysms is increasing with aneurysm size. Small unruptured aneurysms can be treated conservatively with a regular MRI/MRA follow-up to detect a potential increase in size. If coiling is still the main endovascular technique for the treatment of unruptured aneurysms, several other techniques are now available including stent-assisted coiling, flow diversion, and flow disruption. After ARUBA study, there is no recommendation to treat unruptured brain AVMs. According to their hemorrhagic risk, dural arteriovenous fistulas with cortical venous drainage have to be treated, generally by endovascular approach through an arterial route.
Collapse
Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, service de neuroradiologie, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| |
Collapse
|
4
|
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: 31] [Impact Index Per Article: 6.2] [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.
Collapse
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
| |
Collapse
|
5
|
Kortman H, Boukrab I, Sluzewski M, van Rooij WJ, Peluso JP, Majoie C. Endovascular treatment of dural arteriovenous fistulas with sinus drainage: Do we really need to protect the sinus? Interv Neuroradiol 2019; 25:315-321. [PMID: 30714503 DOI: 10.1177/1591019918819187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Dural arteriovenous fistulas (DAVFs) with direct antegrade sinus drainage have a benign natural history but bruit can be disabling. Disconnection of the draining sinus is considered curative. We present the treatment results of 14 patients with a dural arteriovenous fistula with antegrade sinus return with emphasis on functionality of the involved sinus and the need for sinus patency. MATERIALS AND METHODS Between January 2009 and January 2018, 14 patients with a DAVF with direct antegrade sinus drainage were treated in our institution. There were two men and 12 women (1: 6) with a mean age of 61 years (median 61, range 43-78). Clinical presentation was unbearable pulsatile bruit in all cases. Thirteen were draining in the sigmoid or transverse sinus and one drained into the inferior petrosal sinus. RESULTS Twelve of 14 (86%) patients had a draining sinus non-functional for the brain. In ten of these 12 patients the sinus was occluded with liquid embolic or coils. In the two patients with a functional sinus, the fistula was successfully occluded without occluding the sinus. One patient with inferior petrosal sinus drainage required transvenous embolization. There were no permanent adverse events of treatment. CONCLUSIONS Patients with DAVFs with direct antegrade sinus drainage were cured using a strategy of endovascular transarterial and transvenous embolization. Most patients had a non-functional sinus that could be occluded for cure.
Collapse
Affiliation(s)
- Hans Kortman
- 1 Tweesteden Ziekenhuis Vestiging Sint Elisabeth, Tilburg, Netherlands
| | - Issam Boukrab
- 1 Tweesteden Ziekenhuis Vestiging Sint Elisabeth, Tilburg, Netherlands
| | - Menno Sluzewski
- 1 Tweesteden Ziekenhuis Vestiging Sint Elisabeth, Tilburg, Netherlands
| | | | | | - Charles Majoie
- 3 Amsterdam University Medical Center, Amsterdam, Netherlands
| |
Collapse
|
6
|
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: 28] [Impact Index Per Article: 5.6] [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.
Collapse
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
| |
Collapse
|