Sphenoid wing dural arteriovenous fistula: A case report and literature review

Endovascular treatment for sphenoidal region dural arteriovenous fistula

Sphenoidal region dural arteriovenous fistulas (DAVFs) are rare. Endovascular treatment (EVT) is an effective treatment approach. However, understanding and performing EVT for sphenoidal region DAVFs are difficult and challenging. Therefore, we performed a review to explore this issue further. In this review, we discuss the dural feeders and venous structures of the sphenoidal region, the angioarchitecture of sphenoidal region DAVFs, the role and principle of EVT, various EVT techniques, and the prognosis and complications associated with EVT. We found that various EVT techniques, including transarterial embolization (TAE), retrograde transvenous embolization (TVE), and direct puncture EVT, can be used to treat sphenoidal region DAVFs. TAE represents the most commonly utilized approach. TVE and direct puncture EVT should be limited to highly selective cases. EVT must penetrate the fistula and very proximal venous recipient pouch with a liquid embolic agent or coil the fistula point to have a complete curative effect. Successful EVT can lead to the obliteration of sphenoidal region DAVFs and a good clinical outcome. However, these complications cannot be neglected.

Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report

Craniotomy is known as a cause of iatrogenic dural cerebral arteriovenous fistula (AVF). However, mixed pial and dural AVFs after craniotomy are extremely rare and require accurate diagnosis and prompt treatment due to their aggressiveness. We present a case of an iatrogenic mixed pial and dural AVF diagnosed 2 years after pterional craniotomy for surgical clipping of a ruptured anterior choroidal aneurysm. The lesion was successfully treated using single endovascular procedure of transvenous coil embolization through the engorged vein of Labbe and the superficial middle cerebral vein. The possibility of the AVF formation after the pterional approach should always be kept in mind because it usually occurs at the middle cranial fossa, which frequently has an aggressive nature owing to direct cortical venous or leptomeningeal drainage patterns. This complication is believed to be caused by angiogenetic conditions due to coagulation, retraction, and microinjuries of the perisylvian vessels, and can be prevented by performing careful sylvian dissection according to patient-specific perisylvian venous anatomy.