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Ikeuchi Y, Fujita A, Kohta M, Yamanishi S, Tanaka K, Sasayama T. Multiple Synchronous Spinal Dural Arteriovenous Fistulas: A Systematic Literature Review. Neurosurgery 2024; 95:751-760. [PMID: 38647293 DOI: 10.1227/neu.0000000000002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal dural arteriovenous fistulas (SDAVFs) lead to progressive neurological decline with symptoms such as paraparesis, bowel and bladder dysfunction, and sensory disturbances because of impaired spinal cord venous drainage. This study aimed to systematically review the literature on multiple synchronous SDAVFs and present 2 cases from our institution. METHODS A comprehensive search was performed to identify all published cases of multiple synchronous SDAVFs. Overall, 23 patients with multiple synchronous SDAVFs were identified, including 21 from 19 articles and 2 from this study. The clinical presentation, lesion location, radiographic features, surgical treatment, and outcomes were analyzed in each patient. RESULTS All patients in this study were male, and the duration from symptom onset to diagnosis in many of these patients was longer than that previously reported. Previous studies suggested that multiple SDAVFs typically occurred within 3 or fewer vertebral levels. However, >50% of the examined patients had remote lesions separated by more than 3 vertebral levels. Patients with remote lesions had a significantly worse outcome (1/7 vs 8/11, 95% CI 0.001-0.998; P = .049). CONCLUSION Accurately locating fistulas before spinal angiography is critical for managing multiple remote SDAVFs. Considering the possibility of multiple remote SDAVFs, careful interpretation of imaging findings is essential for an accurate diagnosis and appropriate treatment planning.
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Affiliation(s)
- Yusuke Ikeuchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe , Japan
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2
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Elhussein N, A. AlHarbi M, Hamd ZY, Alorainy AI, Elshanawani M, Alsuhabani E, Alhariqi B, Abdullah Alhomida B, Hassan A. B. A. The impact of different imaging modalities in diagnosis and management of patient with dural arteriovenous fistula: A rare case report. Trauma Case Rep 2024; 52:101044. [PMID: 38952476 PMCID: PMC11214945 DOI: 10.1016/j.tcr.2024.101044] [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] [Accepted: 06/04/2024] [Indexed: 07/03/2024] Open
Abstract
In vascular neurosurgery, dural arteriovenous fistulas (DAVFs) are a difficult, challenging condition whose natural history and therapy are still debated. This case report presented a 30-year-old male patient who experienced intermittent headaches for two months, along with gradual weakness in all four limbs, resulting in quadriplegia. Magnetic resonance imaging (MRI), computed tomography (CT), and digital subtraction angiography (DSA) played a significant role in the diagnosis of the patient, in which the final diagnosis was vascular myelopathy due to Dural arteriovenous fistula (DAVF). A successful embolization procedure of arteriovenous fistula using balloon-assisted liquid embolic agents, through branches of the right occipital artery was performed, resulting in complete obliteration of the fistula. In order to improve the neurovascular symptoms that had previously been reported, the patient was effectively undergoing rehabilitation, with notable progress.
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Affiliation(s)
- Nagwan Elhussein
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
| | - Mohammed A. AlHarbi
- Medical Imaging Department, King Abdullah bin Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
| | - Zuhal Y. Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.0 Box 84428, Riyadh 11671, Saudi Arabia
| | - Amal I. Alorainy
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.0 Box 84428, Riyadh 11671, Saudi Arabia
| | - Mansour Elshanawani
- Medical Imaging Department, King Abdullah bin Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
| | - Eyas Alsuhabani
- Medical Imaging Department, King Abdullah bin Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
| | - Bader Alhariqi
- Medical Imaging Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Abdoelrahman Hassan A. B.
- Department of Radiotherapy, College of Medical Radiologic Sciences, Sudan University of Science and Technology, P.O. Box 11111, Khartoum, Sudan
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3
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Shima S, Sato S, Kushi K, Okada Y, Niimi Y. Sinus reconstruction therapy for superior sagittal sinus dural arteriovenous fistula caused by parasagittal meningioma invasion: a case report. Neuroradiol J 2024; 37:237-243. [PMID: 37142419 PMCID: PMC10973827 DOI: 10.1177/19714009231173103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
A dural arteriovenous fistula (dAVF) involving the superior sagittal sinus (SSS) is relatively rare, and its clinical course is usually aggressive. Its concomitance with a tumor has rarely been reported. Here, we present a case of SSS dAVF due to meningioma invasion, which was treated with sinus reconstruction and endovascular embolization. A 75-year-old man who had undergone tumor resection for parasagittal meningioma 4 years prior presented with intra-ventricular hemorrhage. Computed tomography angiography and magnetic resonance imaging revealed recurrent tumor invasion into the SSS causing occlusion. Cerebral angiography revealed multiple shunts along the occluded segment of the SSS, diffuse deep venous congestion, and cortical reflux. Borden type 3 SSS dAVF was diagnosed. We first performed direct tumor resection, followed by stenting for the occluded SSS and partial embolization of the shunts. After a 6-month interval, transvenous occlusion of the SSS was performed along the stent, resulting in complete obliteration of the dAVF. Sinus reconstruction therapy was effective in the immediate improvement of venous hypertension, obtaining the access route to the fistulas, and eradicating the shunts.
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Affiliation(s)
- Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Yosikazu Okada
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
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4
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Mochizuki T, Ryu B, Sato S, Kawamata T, Niimi Y. De Novo Radicular Arteriovenous Fistula After Treatment of Spinal Arteriovenous Fistula: A Case Report and Literature Review. Cureus 2023; 15:e43348. [PMID: 37700934 PMCID: PMC10493201 DOI: 10.7759/cureus.43348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
De novo spinal dural arteriovenous fistulas (AVFs) have been reported as metachronous AVFs However, metachronous spinal AVFs are extremely rare, and their pathogenesis remains uncertain. We report a case of de novo radicular AVF (RAVF) following treatment for spinal AVF at the craniocervical junction (CCJ). We also reviewed the literature and discussed the pathogenesis of metachronous spinal AVF. A 64-year-old male patient diagnosed with spinal AVF at the CCJ supplied from the right C1 segmental artery was treated with Onyx-18 (eV3 Inc, CA, USA) trans-arterial embolization, resulting in partial occlusion. Angiography showed a slight residual shunt two weeks after the embolization without another shunt lesion. A five-year follow-up spinal angiography showed de novo RAVF at the C4 level and complete occlusion of the first AVF. The second AVF was not treated because it was asymptomatic, and the patient remained asymptomatic. De novo RAVF was found to develop five years after the embolization of a CCJ-spinal AVF in a patient. This is the first case of de novo RAVF post-treatment of a spinal AVF. This case demonstrated that RAVF could develop as an acquired disease.
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Affiliation(s)
- Tatsuki Mochizuki
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, JPN
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, JPN
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, JPN
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, JPN
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, JPN
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5
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Lu H, Ma YJ, Liu H, Li HF. Clinical Reasoning: A 49-Year-Old Woman With Isolated Sinus Intracranial Dural Arteriovenous Fistula With Perimedullary Drainage. Neurology 2023; 100:921-926. [PMID: 36690454 PMCID: PMC10186218 DOI: 10.1212/wnl.0000000000206824] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
While demyelination is the most common etiology of longitudinally extensive myelopathy, other causes are important to recognize. In this study, we present the case of a longitudinal cervical lesion with a very rare cause. We discuss the approach to the differential diagnosis and workup for longitudinal myelopathy. This clinical reasoning case also illustrates the anatomical relationship between symptomatic spinal cord lesions and nonsymptomatic intracranial etiologies.
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Affiliation(s)
- Hui Lu
- From the Department of Neurology (H. Lu, H.-F.L.); Department of Neurosurgery (Y.M.), Xuanwu Hospital, Capital Medical University, Beijing; and Department of Neurology (H. Liu), The Affiliated Hospital of Chengde Medical College, Hebei, China
| | - Yong-Jie Ma
- From the Department of Neurology (H. Lu, H.-F.L.); Department of Neurosurgery (Y.M.), Xuanwu Hospital, Capital Medical University, Beijing; and Department of Neurology (H. Liu), The Affiliated Hospital of Chengde Medical College, Hebei, China
| | - Heng Liu
- From the Department of Neurology (H. Lu, H.-F.L.); Department of Neurosurgery (Y.M.), Xuanwu Hospital, Capital Medical University, Beijing; and Department of Neurology (H. Liu), The Affiliated Hospital of Chengde Medical College, Hebei, China
| | - Hai-Feng Li
- From the Department of Neurology (H. Lu, H.-F.L.); Department of Neurosurgery (Y.M.), Xuanwu Hospital, Capital Medical University, Beijing; and Department of Neurology (H. Liu), The Affiliated Hospital of Chengde Medical College, Hebei, China.
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6
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Alkhaibary A, Alnefaie N, Alharbi A, Alammar H, Arishy AM, Alshaya W, Khairy S. Intracranial dural arteriovenous fistula: a comprehensive review of the history, management, and future prospective. Acta Neurol Belg 2022; 123:359-366. [PMID: 36374476 DOI: 10.1007/s13760-022-02133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022]
Abstract
Dural arteriovenous fistulas (DAVF) are abnormal acquired intracranial vascular malformations consisting of pathological connections located within the dura between the pial arteries and the veno vasora, comprising the walls of the dural sinuses, bridging veins, or transosseous emissary veins. Dural arteriovenous fistulas are distinguished from arteriovenous malformations by their arterial supply from the vessels that perfuse the dura mater and lack of a parenchymal nidus. They are most commonly situated at the transverse and cavernous sinuses. The mechanism of development behind dural arteriovenous fistula can be explained by the molecular and anatomical factors. Multiple classification systems have been proposed throughout history including; Djindjian and Merland, Cognard, and Borden classification systems. The aggressiveness of the clinical course in intracranial dural arteriovenous fistula can be predicted through the angiographic patterns of venous drainage, more specifically, the presence of cortical venous drainage, the presence of venous ectasia, and the aggressiveness of clinical presentation. Intracranial dural arteriovenous fistulas might be discovered incidentally. However, if symptomatic, the clinical presentation ranges from mild neurological deficits to severe, lethal intracranial hemorrhage. Angiography is the imaging of choice to investigate, diagnose, and plan treatment for intracranial dural arteriovenous fistula. The management algorithm of intracranial dural arteriovenous fistula can be broadly divided into conservative, surgical, endovascular, and/or radiosurgical options. With the advent of endovascular therapies, surgery has fallen out of favor for managing intracranial dural arteriovenous fistulas. In the present article, the pathophysiology, classifications, natural history, clinical manifestations, radiological features, management, and complications are comprehensively reviewed.
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7
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Negro A, Somma F, Piscitelli V, La Tessa GME, Sicignano C, Fasano F, Tamburrini S, Vargas O, Pace G, Iannuzzi M, Villa A, Della Gatta L, Chiaramonte C, Caranci F, Tortora F, D’Agostino V. Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography? Tomography 2021; 7:804-814. [PMID: 34941640 PMCID: PMC8703900 DOI: 10.3390/tomography7040068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.
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Affiliation(s)
- Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
- Correspondence:
| | - Francesco Somma
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Valeria Piscitelli
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Giuseppe Maria Ernesto La Tessa
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Carmine Sicignano
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Fabrizio Fasano
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy;
| | - Ottavia Vargas
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Gianvito Pace
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
| | - Michele Iannuzzi
- Department of Anesthesia and Intensive Care, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy;
| | - Alessandro Villa
- Department of Neurorsurgery, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (A.V.); (C.C.)
| | - Luigi Della Gatta
- Department of Neuoradiology, AORN A.Cardarelli, via Antonio Cardarelli, 80131 Naples, Italy;
| | - Carmela Chiaramonte
- Department of Neurorsurgery, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (A.V.); (C.C.)
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via de Crecchio, 80138 Naples, Italy;
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, Federico II University Naples, 80131 Naples, Italy;
| | - Vincenzo D’Agostino
- Department of Neuroradiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy; (F.S.); (V.P.); (G.M.E.L.T.); (C.S.); (F.F.); (O.V.); (G.P.); (V.D.)
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8
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Metachronous spinal dural arteriovenous fistula: Case report and review of literature on implications for pathophysiology and management. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Hendriks EJ, Lynch J, Swaminathan SK, Nicholson P, Agid R, Radovanovic I, Pereira VM, terBrugge K, Krings T. Embolization strategies for intracranial dural arteriovenous fistulas with an isolated sinus: a single-center experience in 20 patients. J Neurointerv Surg 2021; 14:605-610. [PMID: 34083397 DOI: 10.1136/neurintsurg-2021-017652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/26/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (DAVFs) draining into an isolated sinus segment constitute a specific entity within the spectrum of cranial dural AV shunts, with under-reporting of their optimal treatment. OBJECTIVE To describe the multimodal treatment approach to isolated sinus DAVFs in a large single-center cohort. METHODS Retrospective analysis of adult patients with an isolated sinus DAVF treated at our institution between 2004 and 2020 was performed. Cases were analyzed for demographics, clinical presentation, angiographic findings, treatment techniques, angiographic and clinical outcomes, and complications. RESULTS Of 317 patients with DAVFs, 20 (6.3%) with an isolated sinus DAVF underwent treatment. Transarterial embolization was performed through the middle meningeal artery in 9 of 12 procedures, with a success rate of 66.7%. Transarterial glue embolization proved successful in two of five procedures (40%) and Onyx in six of seven procedures (85.7%). Transvenous embolization (TVE) with navigation via the occlusion into the isolated sinus was successful in seven out of nine procedures (77.8%). All three open TVE and one pure open surgical procedure gained complete closure of the fistula. There were two major complications. Complete occlusion of the fistula was eventually obtained in all cases (100%). CONCLUSIONS Isolated sinus DAVFs are always aggressive and require a multimodal approach to guarantee closure of the shunt. Transarterial treatment with Onyx achieves good results. Transvenous treatment appears equally successful, navigating into the occluded segment across the occlusion or via burr hole as backup.
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Affiliation(s)
- Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karel terBrugge
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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10
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Corbelli I, De Maria F, Eusebi P, Romoli M, Cardaioli G, Hamam M, Floridi P, Cupini LM, Sarchielli P, Calabresi P. Dural arteriovenous fistulas and headache features: an observational study. J Headache Pain 2020; 21:6. [PMID: 31948389 PMCID: PMC6966899 DOI: 10.1186/s10194-020-1073-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed. METHODS Data of 42 intracranial dural arteriovenous fistulas of 40 patients concerning demographic characteristics, medical history and risk factors, clinical presentation and headache features, location and neuroimaging findings, as well as treatment and outcome, were collected. Furthermore, we used the modified-Rankin Scale to assess the long-term outcome, by telephone contact with patients and/or their relatives. RESULTS Patients aged between 25 and 89 years (mean age 55.8 ± 15.5). According to different clinical presentation and evolution, related to their unique drainage pattern into the cavernous sinus, we examined the carotid-cavernous fistulas separately from other dural arteriovenous fistulas. Interestingly, we found that the migraine-like headache was the major onset symptom of dural arteriovenous fistulas different from carotid-cavernous fistulas (p = 0.036). On the other hand, non-migraine-like headache was a typical characteristic of carotid-cavernous fistulas (p = 0.003). Moreover, ocular symptoms were more frequently observed in carotid-cavernous fistulas (92.9% p < 0.001). Seventy percent of patients did not report any impact on quality of life (mRS 0 or 1) at follow-up. CONCLUSIONS These findings suggest a link between the site of lesion and clinical features of the headache, a symptom that usually leads to hospitalization. In particular, ocular symptoms accompanying non-migraine-like headache should be promptly recognized and raise the suspicion of a carotid-cavernous fistula, while migraine-like headache may suggests other dural arteriovenous fistulas. This study provides new significant insights on headache and its characteristics as a presentation symptom in dural arteriovenous fistulas.
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Affiliation(s)
- Ilenia Corbelli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Francesca De Maria
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Paolo Eusebi
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Michele Romoli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Gabriela Cardaioli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Mohammed Hamam
- Servizio di Angiografia Interventistica, Ospedale S.M. Misericordia, Perugia, Italy
| | - Piero Floridi
- Servizio di Neuroradiologia, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Letizia Maria Cupini
- Centro Cefalee e Malattie Cerebrovascolari, UOC Neurologia-Stroke Unit, Ospedale S. Eugenio, Rome, Italy
| | - Paola Sarchielli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Misericordia - S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Paolo Calabresi
- Clinica Neurologica, Dipartimento di Neuroscienze, Policlinico Gemelli, Università Cattolica, Rome, Italy
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11
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Ren Y, Liu H, Chen TY, Li J. True metachronous multiple spinal dural arteriovenous fistulas: case report and review of the literature. Br J Neurosurg 2019:1-5. [PMID: 31204526 DOI: 10.1080/02688697.2019.1630556] [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: 02/05/2023]
Abstract
Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal vascular disorders. Multiple spinal DAVFs are very rare, and the majority of them appear synchronously. True metachronous multiple spinal DAVFs occur even more rarely. We report a case of true metachronous multiple spinal DAVFs. A 61-year-old male presented with progressive paraparesis. Spinal MRI showed extensive edema of the spinal cord from T5 to the conus and prominent vascular flow voids. MR angiography showed a left T10 DAVF. The fistula was treated surgically and the clinical symptoms gradually resolved. Recurrence of symptoms occurred 4 months after surgery. A second angiography showed a new fistula located at the right L1. The second fistula was treated surgically and the symptoms again gradually improved. Metachronous multiple spinal DAVF may present within 4 months of each other.
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Affiliation(s)
- Yanming Ren
- a Department of Neurosurgery , West China Hospital of Sichuan University, Chengdu , Sichuan , PR China
| | - Hao Liu
- a Department of Neurosurgery , West China Hospital of Sichuan University, Chengdu , Sichuan , PR China
| | - Teng-Yun Chen
- a Department of Neurosurgery , West China Hospital of Sichuan University, Chengdu , Sichuan , PR China
| | - Jin Li
- a Department of Neurosurgery , West China Hospital of Sichuan University, Chengdu , Sichuan , PR China
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Dural Arteriovenous Fistula Presenting as Tentorial Subdural Hemorrhage : Case Report and Review of the Literature. Clin Neuroradiol 2018; 29:555-561. [PMID: 30564840 DOI: 10.1007/s00062-018-0752-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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13
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Chen CC, Cho YD, Yoo DH, Moon J, Lee J, Kang HS, Kim JE, Cho WS, Han MH. Endovascular management of multiple intracranial dural arteriovenous fistulas. J Neuroradiol 2018; 46:390-397. [PMID: 30448429 DOI: 10.1016/j.neurad.2018.10.010] [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] [Received: 07/15/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Multiply occurring intracranial dural arteriovenous fistulas (dAVFs) have been documented but rarely occur, and neither pathogenesis nor prognosis is clearly understood. This study was conducted to analyze angiographic characteristics of multiple dAVFs and to chronicle our treatment experience. METHODS Between April, 2002 and January, 2018, data prospectively collected from 310 patients with intracranial dAVFs were systematically reviewed, assessing clinical and anatomic outcomes of endovascular treatment in 32 patients with multiple dAVFs (≥ 2 fistulas each). Lesions were categorized as multifocal or diffuse type, depending on presentation, and further characterized as progressive or non-progressive disease. RESULTS Overall, 18 patients (56.3%) experienced aggressive presentations, including intracerebral hemorrhage or venous infarction. Cortical venous reflux (CVR) was observed in 26 patients (81.3%), and sinus thrombosis or occlusion was seen in 24 (75.0%). Clinical outcomes in patients with multifocal fistulas (n = 11) were excellent (100%), marked by a moderately high rate of complete occlusion (54.5%). Those with progressive disease (n = 10) regularly displayed certain angiographic findings, namely diffuse configuration (100%), sinus thrombosis (100%), and CVR (100%). Complete anatomic obliteration was achieved in 12 patients (37.5%), and in 26 patients (81.3%), clinical outcomes were favorable. CONCLUSION Multiple dAVFs are typically aggressive at presentation, given strong associations with CVR and sinus thrombosis. In diffuse-type fistulas, the potential to recur or progress is high. Although definitive treatment poses a challenge, outcomes of endovascular therapeutics may be still optimized in this setting through strategic procedural modifications and careful follow-up monitoring.
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Affiliation(s)
- Ching-Chang Chen
- Department of Neurosurgery, Chang Gung University and Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jusun Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeongjun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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14
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Jablawi F, Mull M. Double spinal dural arteriovenous fistulas. J Neuroradiol 2018; 46:168-172. [PMID: 30389511 DOI: 10.1016/j.neurad.2018.09.004] [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: 11/05/2017] [Revised: 07/04/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Spinal dural arteriovenous fistulas (SDAVF) are usually solitary lesions. Synchronous and/or metachronous double SDAVF have rarely been reported in the literature. We report on three patients with double SDAVF and present our single center experience in the diagnostic and treatment management in these patients. MATERIAL AND METHODS We retrospectively revised our medical database for all patients who were diagnosed and treated in our center due to a SDAVF between 1990 and 2017. All data including demographics, clinical presentations, as well as radiological data were re-evaluated for this study. RESULTS Three (1.4%) of 209 consecutive patients with SDAVF presented double SDAVF with different arterial feeders and venous drainage patterns. All three patients were men. The mean age at time of diagnosis was 67.9 ± 10 years (median; 68, range: 53-82). Myelopathic symptoms were reported in all three cases. All three fistulas were located in the thoracolumbar region between T7 and L2. MRI/CE-MRA showed medullar T2-hyperintensity, intramedullary contrast-enhancement and dilatation of perimedullary veins in various extensions. CONCLUSION Double SDAVF are extremely rare and were found in 1.4% of patients in our series. The vast majority of the reported double SDAVF in the literature has been detected synchronously within an area of equal or less than three vertebral levels. Thus, whenever the SDAVF is identified, further injections of the fistula-zone neighbored segmental arteries might be recommended. However, due to the extremely low incidence of double SDAVF a complete spinal DSA is not indicated.
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Affiliation(s)
- F Jablawi
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstrasse, 30, 52074 Aachen, Germany; Department of Neurosurgery, Justus-Liebig-University, Klinikstrasse, 33, 35392 Giessen, Germany
| | - M Mull
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstrasse, 30, 52074 Aachen, Germany.
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Tsuei YS, Chou YE, Chen WH, Luo CB, Yang SF. Polymorphism in dural arteriovenous fistula: matrix metalloproteinase-2-1306 C/T as a potential risk factor for sinus thrombosis. J Thromb Haemost 2018; 16:802-808. [PMID: 29431912 DOI: 10.1111/jth.13973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Essentials Sinus thrombosis may play a crucial role in development of dural arteriovenous fistula (DAVF). Little is known about the association between gene polymorphism and the development of DAVF. MMP-2-1306 C/T showed a higher prevalence rate in DAVF cases with sinus thrombosis. MMP-2-1306C/T polymorphism is likely a potential risk factor for sinus thrombosis in DAVF. SUMMARY Background Dural arteriovenous fistula (DAVF) is a rare but important cerebrovascular disorder in adults. Little is known about the molecular genetic pathogenesis underlying DAVF development. Objectives To investigate the associations of gene polymorphisms and DAVF. Materials and Methods By the use of real-time PCR genotyping, seven single-nucleotide polymorphisms (SNPs) of angiogenesis-related genes were analyzed in 72 DAVF patients. Pertinent clinical and imaging data were subgrouped on the basis of location (cavernous sinus versus lateral sinus), lesions (single versus multiple), cerebral venous reflux (CVR) grading (Borden I versus Borden II/III), and sinus thrombosis (with versus without). Results We found that individuals carrying the polymorphic allele of matrix metalloproteinase (MMP)-2-1306 C/T (rs243865) had a significantly increased risk of sinus thrombosis in DAVF (odds ratio 6.2; 95% confidence interval 1.7-22.9). There was a weak difference in associations of tissue inhibitor of metalloproteinase (TIMP)-2 (rs2277698) gene polymorphism and DAVF patients subgrouped by CVR grading. Conclusions These preliminary results indicate that MMP-2-1306 C/T, but not MMP-9, TIMP-1, TIMP-2, and vascular endothelial growth factor A SNP variants, is a risk factor for the development of sinus thrombosis in DAVF patients.
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Affiliation(s)
- Y-S Tsuei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Y-E Chou
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - W-H Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-B Luo
- Institute of Biomedical Engineering, Yuanpei University, Hsinchu, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - S-F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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16
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Rhim JK, Cho YD, Yoo DH, Kang HS, Cho WS, Kim JE, Cho MJ, Hwang G, Kwon OK, Han MH. Endovascular Treatment of Bilateral Cavernous Sinus Dural Arteriovenous Fistula: Therapeutic Strategy and Follow-Up Outcomes. Korean J Radiol 2018. [PMID: 29520192 PMCID: PMC5840063 DOI: 10.3348/kjr.2018.19.2.334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization. Materials and Methods Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment. Results At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits. Conclusion With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.
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Affiliation(s)
- Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63241, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Min Jae Cho
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - Gyojun Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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Guo Y, Yu J, Zhao Y, Yu J. Progress in research on intracranial multiple dural arteriovenous fistulas. Biomed Rep 2017; 8:17-25. [PMID: 29399335 PMCID: PMC5772627 DOI: 10.3892/br.2017.1021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
Intracranial multiple dural arteriovenous fistulas (MDAVFs) are rare lesions that are difficult to treat. The key factors involved in the development of MDAVFs remain unknown. At present, the majority of reports on intracranial MDAVFs are confined to case reports and small case series, and thus understanding of MDAVFs is limited. The current review assesses the available literature to date with the aim of reviewing the progress in research on intracranial MDAVFs. Intracranial MDAVFs may be divided into two types: Synchronous and metachronous. While the exact pathogenesis of MDAVFs is unknown, a number of possible mechanisms are considered relevant. The first is that MDAVFs develop following recanalization of a large sinus thrombosis that involves several sinuses. The second possibility is that a pre-existing DAVF may induce sinus thrombosis or venous hypertension, resulting in a new MDAVF. The third is that MDAVFs are caused by increased angiogenic activity, which may induce the development of MDAVFs. Intracranial MDAVFs have a malignant clinical course, and their symptoms generally rapidly progress following onset. It is therefore important to identify intracranial MDAVFs at an early stage. A number of imaging technologies, including computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and single-photon emission computed tomography (SPECT), may be used to detect MDAVFs. Of these, CT and MRI provide information on brain morphology, SPECT provides brain blood flow information, and DSA is the gold standard that may be used to identify angioarchitecture and hemodynamics. MDAVFs require timely and aggressive treatment, which may include endovascular embolization, surgical resection, radiosurgery and conservative treatment, and in some cases, combined treatments are required. Appropriate and aggressive treatment regimens can markedly improve neurological deficits and cognitive function in patients with MDAVFs.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Yu
- Operating Room, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ying Zhao
- Training Department, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Remote Lesions of Synchronous Sacral and Cervical Dural Arteriovenous Fistulas: A Case Report. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Elia C, Minasian T, Noufal M, Chhabra V. Pial-Dural Intracranial Arteriovenous Fistula with Flow-Associated Aneurysmal Rupture-Case Report with Review of Literature and Proposal on the Mechanism of Hemorrhage and Treatment Options. World Neurosurg 2017; 105:1040.e15-1040.e19. [PMID: 28676463 DOI: 10.1016/j.wneu.2017.06.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular anomalies in the form of dural arteriovenous fistulas (DAVFs), arteriovenous malformations, and aneurysms are well described in the literature. Pial arteriovenous fistulas (PAVFs) are described to a lesser extent in the literature. When these anomalies are combined, diagnosis and treatment become complex. CASE DESCRIPTION A 55-year-old man presented with PAVF/DAVF with a ruptured flow-related aneurysm in the distal left posterior inferior cerebellar artery, which required surgical clipping and disconnection. We performed a PubMed search of all identifiable cases of PAVFs in adults. We then identified which cases had components of DAVFs and flow-related aneurysms. We identified 51 PAVF cases and identified which patients presented with hemorrhage and the treatment modalities of all cases. Of 51 cases identified, 4 were a DAVF/FRA, and 5 were a PAVF/DAVF. One case of PAVF/DAVF/FRA was identified. CONCLUSIONS The exact mechanism of PAVF/DAVF formation is unknown. Hemorrhage predilection of PAVF/DAVF is more difficult to predict than a sole fistula, likely secondary to the complex flow dynamics. To our knowledge, this literature review is the largest review to date regarding PAVFs in adult patients and can provide insight into decision making when evaluating treatment options.
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Affiliation(s)
- Christopher Elia
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California; Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA.
| | - Tanya Minasian
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California
| | - Mazen Noufal
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Vaninder Chhabra
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
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20
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A Case of De Novo Anterior Condylar Dural Arteriovenous Fistula Long after Curative Transvenous Embolization of Contralateral Anterior Condylar Arteriovenous Fistula. Case Rep Med 2016; 2016:6974526. [PMID: 27829838 PMCID: PMC5088320 DOI: 10.1155/2016/6974526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022] Open
Abstract
We report on a 55-year-old man who developed a de novo DAVF in left ACC 5 years after curative transvenous embolization for DAVF in right ACC. Angiography revealed that the de novo lesion demonstrated more aggressive arteriovenous shunt flow than the initial lesion. Successful transvenous embolization was performed for also the second lesion. The authors describe the possible pathophysiological mechanisms and management strategies for this rare occurrence.
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Multiple Dural and Pial Arteriovenous Fistulae in a Twenty-Four-Year-Old Woman in the Setting of Superior Sagittal Sinus Thrombosis: Case Report and Review of Literature. J Stroke Cerebrovasc Dis 2016; 25:e192-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 11/23/2022] Open
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22
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Gailloud P. Early description of synchronous double spinal vascular malformations by Łucja Frey in 1928. J Neurosurg Spine 2016; 25:271-8. [DOI: 10.3171/2016.1.spine151200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Polish neurologist Łucja Frey (1889–1942) is principally remembered for her description of the auriculotemporal nerve (or Frey's) syndrome. She also reported a complex case of spinal cord vascular malformation in 1928, which included one of the earliest accurate anatomopathological depictions of a spinal arteriovenous malformation as well as the first known observation of double synchronous spinal cord vascular malformation.
An abbreviated translation of Frey's report is followed by a discussion of the place occupied by her contribution in the development of our current understanding of spinovascular disorders.
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Tsai LK, Liu HM, Jeng JS. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Rev Neurother 2016; 16:307-18. [PMID: 26832225 DOI: 10.1586/14737175.2016.1149063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Avecillas-Chasín JM, Brin JR, Lopez-Ibor L, Gomez G, Rodriguez-Boto G. Multiple spinal arteriovenous fistulas: A case-based review. Clin Neurol Neurosurg 2015; 139:6-11. [DOI: 10.1016/j.clineuro.2015.08.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/13/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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25
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Wang JY, Molenda J, Bydon A, Colby GP, Coon AL, Tamargo RJ, Huang J. Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci 2015. [PMID: 26195333 DOI: 10.1016/j.jocn.2015.05.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) located at the craniocervical junction are rare vascular malformations with distinctive features, and their natural history and the optimal treatment strategy remains unclear. We retrospectively reviewed eight patients with craniocervical junction DAVF who were evaluated at our institution between 2009 and 2012. We also conducted a MEDLINE search for all reports of craniocervical junction DAVF between 1970 and 2013, and reviewed 119 patients from 56 studies. From a total of 127 patients, 46 (37.1%) presented with myelopathy, 53 (43.1%) with subarachnoid hemorrhage (SAH), and four (3.3%) with brainstem dysfunction. SAH was typically mild, most often Hunt and Hess Grade I or II (83.3%), and associated with ascending venous drainage via the intracranial veins (p<0.001). Higher rates of obliteration were observed after microsurgery compared to embolization. Overall, younger age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.12; p=0.011), hemorrhagic presentation (OR 0.17; 95% CI 0.06-0.50; p=0.001), and microsurgery (OR 0.23; 95% CI 0.08-0.6; p=0.004) were independently predictive of good outcome at the last follow-up. Microsurgery was the only independent predictor of overall improvement at the last follow-up (OR 4.35; 95% CI 1.44-13.2; p=0.009). Prompt diagnosis and microsurgical management, offering a greater chance of immediate obliteration, may optimize the outcomes for patients with craniocervical junction DAVF. Endovascular treatment is often not feasible due to lesion angioarchitecture, and is associated with a higher risk of lesion recanalization or recurrence. However, long term studies with newer embolic agents such as Onyx (ev3 Endovascular, Plymouth, MN, USA) are yet to be performed.
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Affiliation(s)
- Joanna Y Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Joseph Molenda
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA.
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Miller TR, Gandhi D. Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management Strategies. Stroke 2015; 46:2017-25. [PMID: 25999384 DOI: 10.1161/strokeaha.115.008228] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Timothy R Miller
- From the Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD.
| | - Dheeraj Gandhi
- From the Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, MD
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Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas. Clin Neurol Neurosurg 2014; 121:64-75. [DOI: 10.1016/j.clineuro.2014.01.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/12/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
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28
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Gist TL, Rangel-Castilla L, Krishna C, Roman GC, Cech DA, Diaz O. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient. J Neurointerv Surg 2013; 6:e16. [PMID: 23493339 DOI: 10.1136/neurintsurg-2012-010619.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension.
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Affiliation(s)
- Taylor L Gist
- Department of Neurosurgery, The Methodist Neurological Institute, Houston, Texas, USA
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Gist TL, Rangel-Castilla L, Krishna C, Roman GC, Cech DA, Diaz O. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient. BMJ Case Rep 2013; 2013:bcr-2012-010619. [PMID: 23475992 DOI: 10.1136/bcr-2012-010619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension.
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Affiliation(s)
- Taylor L Gist
- Department of Neurosurgery, The Methodist Neurological Institute, Houston, Texas 77030, USA.
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Ha SY, Kwon YS, Kim BM, Kim DI, Kim DJ. Clinical and angiographic characteristics of multiple dural arteriovenous shunts. AJNR Am J Neuroradiol 2012; 33:1691-5. [PMID: 22538077 DOI: 10.3174/ajnr.a3054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenesis and characteristics of multiple DAVSs are not well-known. The purpose of this study was to evaluate the angiographic and clinical characteristics of patients with multiple DAVSs with an emphasis on the pathomechanism. MATERIALS AND METHODS One hundred seventy-nine patients with DAVS were reviewed. Patients with ≥ 2 fistulas at anatomically separate sites were included. Multiple DAVSs were categorized into synchronous (simultaneous multiplicity) or metachronous (temporal sequential development of multiplicity) types. The angiographic and clinical characteristics of these lesions were analyzed. RESULTS Fourteen patients were diagnosed with multiple DAVSs (7.8%; synchronous, n = 7; metachronous, n = 7). Thirteen of the 14 patients showed CVR (93%, Borden type II/III). Multiple DAVSs were frequently associated with dural sinus thrombosis (71.4%, n = 10). Synchronous DAVSs developed in association with an occluded sinus (n = 5). De novo metachronous lesions developed in association with thrombosis of a previously patent dural sinus (n = 3) or reopening of an occluded sinus (n = 2). Multiplicity was associated with aggressive initial symptoms in 64.3% (n = 9). The newly developed lesions in the metachronous types were accompanied by hemorrhage (n = 1), neurologic deficit (n = 1), worsening of the initial benign symptoms (n = 2), and incidental detection (n = 3). The mean time interval between the initial diagnosis and de novo lesion detection was 31.3 ± 29.8 months (range, 12-92 months). CONCLUSIONS Multiplicity of DAVSs is associated with poor angiographic and clinical prognosis, requiring an aggressive treatment and management strategy. Sinus thrombosis has a prominent role in the pathomechanism of DAVSs.
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Affiliation(s)
- S Y Ha
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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SASAKI O, YAJIMA N, ICHIKAWA A, YAMASHITA S, NAKAMURA K. Deterioration After Surgical Treatment of Spinal Dural Arteriovenous Fistula Associated With Spinal Perimedullary Fistula. Neurol Med Chir (Tokyo) 2012; 52:516-20. [DOI: 10.2176/nmc.52.516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Osamu SASAKI
- Department of Neurosurgery, Niigata City General Hospital
| | - Naoki YAJIMA
- Department of Neurosurgery, Niigata City General Hospital
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Abstract
Synchronous multiplicity of cranial and spinal dural arteriovenous fistulas (DAVFs) is known but uncommon. The authors report on a patient with the unusual finding of multiple cranial and multiple separate spinal DAVFs. The patient initially presented with vague visual symptoms in 2004. A cranial DAVF was identified along the left transverse sinus with cortical venous reflux and another DAVF was identified along the posterior part of the superior sagittal sinus with no cortical venous reflux. The first DAVF was treated both endovascularly and surgically and the second was left untreated. The follow-up angiogram showed multiple spinal DAVFs at the levels of C-1, C-2, and C-6 on the left side and at the C-3 level on the right side along with another cranial DAVF along the anterior part of the superior sagittal sinus with cortical venous reflux. A retrospective analysis of the digital subtraction angiogram and MR images suggested that the cervical spinal DAVFs were already present in 2004 (6 years previously). Multiple DAVFs, although rare, do exist and it is important to look for any evidence of their presence when evaluating patients with symptoms suggestive of arteriovenous fistulas.
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Oshita J, Yamaguchi S, Ohba S, Kurisu K. Mirror-Image Spinal Dural Arteriovenous Fistulas at the Craniocervical Junction. Neurosurgery 2011; 69:E1166-71. [DOI: 10.1227/neu.0b013e318223bab5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
We report an extremely rare case with mirror-site spinal dural arteriovenous fistulas (DAVFs) at the craniocervical junction. Although multiple spinal DAVFs have been reported in the literature, complete mirror-site lesions with fistulas and feeding arteries in the symmetric position have not been previously described.
CLINICAL PRESENTATION
A 74-year-old man presented with walking disturbance, urinary incontinence, and constipation progressing over a 14-month period. T2-weighted magnetic resonance imaging showed a high-intensity area in the spinal cord at the level from C4 to C6 and multiple flow voids at the surface of the spinal cord. Three-dimensional computed tomographic angiography revealed bilateral DAVFs located in the mirror site of the craniocervical junction. Direct surgery with suboccipital craniectomy and C1 laminectomy revealed dilated tortuous red veins on the dorsal surface of the spinal cord. We found bilateral symmetric red veins around the dural penetration of the vertebral artery. Both red veins were successfully interrupted with the aneurysmal clips. Postoperative 3-dimensional computed tomographic angiography revealed a disappearance of the bilateral fistulas. Magnetic resonance images obtained 6 months after the surgery confirmed the disappearance of the intramedullary high-intensity area and flow voids. The symptoms before the operation improved after surgery, especially urinary incontinence and constipation, with slight walking disturbance.
CONCLUSION
Because fistulas in the present case existed at the same spinal level, we found multiple fistulas on the first examination. This early notification resulted in a good outcome from the first operation. If patients with spinal DAVFs have rapidly progressing symptoms, one should suspect multiple fistulas.
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Affiliation(s)
- Jumpei Oshita
- Department of Neurosurgery, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Satoshi Yamaguchi
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shinji Ohba
- Department of Neurosurgery, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Ros de San Pedro J, Pérez CJP, Parra JZ, López-Guerrero AL, Sánchez JFML. Bilateral ethmoidal dural arteriovenous fistula: unexpected surgical diagnosis. Clin Neurol Neurosurg 2010; 112:903-8. [PMID: 20727670 DOI: 10.1016/j.clineuro.2010.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 05/24/2010] [Accepted: 07/10/2010] [Indexed: 11/29/2022]
Abstract
Dural arteriovenous fistulae (DAVFs) are infrequent lesions, the most common locations of which are the cavernous, sigmoid and transverse sinuses. The cribiform plate is one of the less frequent sites for DAVFs, where they entail a high hemorrhage risk. Feeding arteries for ethmoidal DAVFs can be uni- or bilateral. However, the draining fistulous system has classically been described as unilateral. The authors report the second case in literature of bilateral ethmoidal DAVF, which is defined as that with bilateral draining veins. The present case was diagnosed only after surgical exploration of both cribiform plates. No preoperative radiological test could detect the presence of a bilateral venous draining system from the ethmoidal DAVF. Possible reasons for that lack of presurgical diagnosis are discussed. Bilateral surgical exploration of the anterior cranial fossa is recommended when dealing with ethmoidal DAVFs, even when they seem to be unilateral on preoperative studies.
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Affiliation(s)
- Javier Ros de San Pedro
- Regional Service of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F, Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR Am J Neuroradiol 2010; 31:1512-5. [PMID: 20413606 DOI: 10.3174/ajnr.a2109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Spinal DAVSs of the cervical level are rare lesions. The purpose of this study is to describe the clinical and angiographic characteristics of cervical spinal DAVSs. From a prospectively collected database including 449 cases of brain and spinal DAVSs, lesions located at the cervical level were selected. The clinical presentation, angiographic characteristics, and treatment outcome were assessed. Twelve cases of spinal DAVSs were identified at the level of the cervical spinal canal (male to female ratio = 8:4; mean age = 56.5 years). Five patients (41.7%) presented with hemorrhage including SAH (n = 4) and cerebellar hemorrhage (n = 1). Coincidental spinal DAVSs with cranial DAVSs or brain AVMs were noted in 5 cases (41.7%). The spinal DAVS was the symptomatic lesion in 10 cases and was incidentally discovered during evaluation for SAH from a coincidental lesion in 2 cases. Combined endovascular and surgical resection resulted in symptomatic improvement in 10 patients. In conclusion, DAVSs of the cervical spine are rare lesions which often present with hemorrhage and are frequently associated with complex coincidental vascular lesions. Combined endovascular and surgical treatment will result in good outcome.
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Affiliation(s)
- D J Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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36
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Qian Y. A New Challenge to Estimate the Rupturing Process of ICA Aneurysms. Interv Neuroradiol 2010. [DOI: 10.1177/15910199100160s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Y Qian
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
- Neurosurgery Department, Jikei University School of Medicine, Tokyo, Japan
- Centre for Advanced Biomedical Science, Tokyo, Japan
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Endovascular angioplasty and stent placement in venous hypertension related to dural arteriovenous fistulas and venous sinus thrombosis. Clin Neurol Neurosurg 2010; 112:167-71. [PMID: 19945781 DOI: 10.1016/j.clineuro.2009.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 10/11/2009] [Accepted: 10/31/2009] [Indexed: 11/22/2022]
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Dehdashti AR, Da Costa LB, terBrugge KG, Willinsky RA, Tymianski M, Wallace MC. Overview of the current role of endovascular and surgical treatment in spinal dural arteriovenous fistulas. Neurosurg Focus 2009; 26:E8. [DOI: 10.3171/foc.2009.26.1.e8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dural arteriovenous fistulas are the most common vascular malformations of the spinal cord. These benign vascular lesions are considered straightforward targets of surgical treatment and possibly endovascular embolization, but the outcome in these cases depends mainly on the extent of clinical dysfunction at the time of the diagnosis. A timely diagnosis is an equally important factor, with early treatment regardless of the type more likely to yield significant improvements in neurological functioning. The outcomes after surgical and endovascular treatment are similar if complete obliteration of the fistulous site is obtained. In the present study, the authors evaluated the current role of each modality in the management of these interesting lesions.
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Affiliation(s)
| | - Leodante B. Da Costa
- 2Department of Medical Imaging, Toronto Brain Vascular Malformation Study Group, University of Toronto, Canada
| | - Karel G. terBrugge
- 2Department of Medical Imaging, Toronto Brain Vascular Malformation Study Group, University of Toronto, Canada
| | - Robert A. Willinsky
- 2Department of Medical Imaging, Toronto Brain Vascular Malformation Study Group, University of Toronto, Canada
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Geibprasert S, Pereira V, Krings T, Jiarakongmun P, Toulgoat F, Pongpech S, Lasjaunias P. Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke 2008; 39:2783-94. [PMID: 18635840 DOI: 10.1161/strokeaha.108.516757] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The craniospinal epidural spaces can be categorized into 3 different compartments related to their specific drainage role of the bone and central nervous system, the ventral epidural, dorsal epidural, and lateral epidural groups. We propose this new classification system for dural arteriovenous shunts and compare demographic, angiographic, and clinical characteristics of dural arteriovenous shunts that develop in these 3 different locations. METHODS Three hundred consecutive cases (159 females, 141 males; mean age: 47 years; range, 0 to 87 years) were reviewed for patient demographics, clinical presentation, multiplicity, presence of cortical and spinal venous reflux, and outflow restrictions and classified into the 3 mentioned groups. RESULTS The ventral epidural group (n=150) showed a female predominance, more benign clinical presentations, lower rate of cortical and spinal venous reflux, and no cortical and spinal venous reflux without restriction of the venous outflow. The dorsal epidural group (n=67) had a lower mean age and a higher rate of multiplicity. The lateral epidural group (n=63) presented later in life with a male predominance, more aggressive clinical presentations, and cortical and spinal venous reflux without evidence of venous outflow restriction. All differences were statistically significant (P<0.001). CONCLUSIONS Dural arteriovenous shunts predictably drain either in pial veins or craniofugally depending on the compartment involved by the dural arteriovenous shunt. Associated conditions (outflow restrictions, high-flow shunts) may change that draining pattern. The significant differences between the groups of the new classification support the hypothesis of biological and/or developmental differences in each epidural region and suggest that dural arteriovenous shunts are a heterogeneous group of diseases.
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Affiliation(s)
- Sasikhan Geibprasert
- Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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40
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Singh V, Smith WS, Lawton MT, Halbach VV, Young WL. Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery 2008; 62:628-35; discussion 628-35. [PMID: 18425010 DOI: 10.1227/01.neu.0000317311.69697.fc] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Intracranial dural arteriovenous fistulae (DAVFs) can present as disabling intracranial hemorrhage. The aim of this study was to investigate the independent effects of specific demographic and clinical variables on hemorrhagic presentation in patients with DAVFs. METHODS All patients with DAVFs evaluated at the University of California at San Francisco from July 1988 through June 2004 were identified. Clinical and radiographic characteristics were recorded using a detailed abstraction form. RESULTS A total of 402 patients with DAVFs were identified, 73 (18%) of whom presented with intracranial hemorrhage. Men were twice as likely to present with hemorrhage (men 70% versus women 30%, P < 0.001). Cortical venous drainage (85 versus 22%; P < 0.001), retrograde venous drainage (59 versus 36%; P < 0.001), and sinus occlusion (33 versus 18%; P = 0.004) were also more common in patients with DAVF with hemorrhagic presentation. In multivariate logistic regression analysis, cortical venous drainage (odds ratio [OR], 10.5; P < 0.001), focal neurological deficits (OR, 4.7; P < 0.001), DAVFs in the posterior fossa (OR, 4.0; P = 0.005), male sex (OR, 3.4, P = 0.001), and age older than 50 years were found to be independently associated with hemorrhagic presentation. CONCLUSION Although DAVFs are less frequent in men than in women, they are more likely to present with hemorrhage. In addition to cortical venous drainage, a well-known risk factor for intracranial hemorrhage, posterior fossa location, older age at presentation, and focal neurological deficits were independently associated with hemorrhagic presentation in patients with DAVFs.
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Affiliation(s)
- Vineeta Singh
- Department of Neurology, University of California at San Francisco, San Francisco, CA 94143, USA.
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41
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SAITO A, TAKAHASHI N, FURUNO Y, KAMIYAMA H, NISHIMURA S, MIDORIKAWA H, NISHIJIMA M. Multiple Isolated Sinus Dural Arteriovenous Fistulas Associated With Antithrombin III Deficiency -Case Report-. Neurol Med Chir (Tokyo) 2008; 48:455-9. [DOI: 10.2176/nmc.48.455] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atsushi SAITO
- Department of Neurosurgery, Aomori Prefectural Central Hospital
| | | | - Yuichi FURUNO
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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Posters. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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43
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Day 3 — September 12, 2007. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rizvi T, Garg A, Mishra NK, Gaikwad SB, Gupta V. Metachronous double spinal dural arteriovenous fistulas. J Neurosurg Spine 2006; 4:503-5. [PMID: 16776363 DOI: 10.3171/spi.2006.4.6.503] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
✓ Spinal dural arteriovenous fistulas (DAVFs), the most common of spinal vascular malformations, are AVFs in the dura mater of the nerve root and/or adjacent spinal dura. These fistulas are most often solitary and are fed by a single radicular artery that primarily supplies the dura mater. Multiple spinal DAVFs are rarely reported in the literature. Those that have been documented have been synchronous in their presentation in that they were found during the same examination or were present at the initial examination but missed and only recognized at the second examination. The authors report the case of a patient with two spinal DAVFs occurring at different spinal levels at different points in time (metachronous).
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Affiliation(s)
- Tanvir Rizvi
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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45
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Abstract
PURPOSE OF REVIEW To summarize clinical key points, diagnostic features, and results of imaging and therapy of spinal dural arteriovenous fistula (SDAVF). RECENT FINDINGS SDAVF accounts for 70% of spinal arteriovenous malformation with an annual incidence of 5-10 cases per million. At least 80% of patients are male, and more than 66% of patients are in the sixth and seventh decade of life indicating preponderance of gender and age. Thrombophilia is not a predisposing factor of disease. Clinical course is predominated by symptoms of congestive myelopathy, but subarachnoid hemorrhage may occur. Double SDAVF is a rare problem in the management of disease. Magnetic resonance imaging has replaced myelography as screening procedure. Contrast-enhanced magnetic resonance angiography and multislice computerized tomographic angiography may facilitate diagnostic procedure, however, spinal angiography is still required to confirm diagnosis. Treatment by permanent occlusion of fistula results in clinical improvement in 70% of cases. Microsurgical shunt interruption has proven secure and reliable. Endovascular shunt embolization has been established as a standardized procedure, but occlusion rates are still lower than in surgical treatment. SUMMARY Advances have been made in diagnosis and treatment of SDAVF, but the disease is still not completely understood.
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Affiliation(s)
- Christoph Koch
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
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46
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Ling JCM, Agid R, Nakano S, Souza MPS, Reintamm G, Terbrugge KG. Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia. Interv Neuroradiol 2005; 11:79-82. [PMID: 20584440 DOI: 10.1177/159101990501100113] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 02/20/2005] [Indexed: 11/15/2022] Open
Abstract
SUMMARY HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography.
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Affiliation(s)
- J C M Ling
- Department of Medical Imaging, Buddhist Tzu Chi Medical Center, Hualien; Taiwan -
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47
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Krings T, Mull M, Reinges MHT, Thron A. Double spinal dural arteriovenous fistulas: case report and review of the literature. Neuroradiology 2004; 46:238-42. [PMID: 15034701 DOI: 10.1007/s00234-003-1147-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 11/11/2003] [Indexed: 11/26/2022]
Abstract
Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patient's neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement.
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Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
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48
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Fiumara E, Tumbiolo S, Bellomonte ML, Savatteri P, Finazzo F, La Gattuta F. Resection of the transverse sinuses and confluence of sinuses for treatment of multiple dural arteriovenous fistulas. J Neurosurg 2004; 100:348-52. [PMID: 15086246 DOI: 10.3171/jns.2004.100.2.0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) occurring simultaneously at two or more separate locations are not frequent. In fact, the incidence of multiple DAVFs is 7 to 8% of all DAVFs. Patients harboring multiple DAVFs have a higher incidence of hemorrhage, venous infarction, and neurological deficits due to a greater frequency of leptomeningeal venous drainage. To the authors' knowledge only a few cases of DAVFs involving both transverse sinuses (TSs) have been reported. These patients underwent various combined treatments (transarterial embolization, transvenous obliteration, surgical isolation, resection, and radiosurgery). Treatments performed that do not include resection of the involved sinuses do not always guarantee a cure. The authors present a patient who harbored multiple DAVFs of the TSs, both distally occluded with secondary reflux into the superior sagittal sinus (SSS), the straight sinus, the deep venous system, and the leptomeningeal veins of both hemispheres. An en bloc removal of the portions including the fistulas of the TSs, the confluence of sinuses, and the distal parts of the SSS, and straight sinus allowed for the patient to be cured. The fact is emphasized that despite the progress of endovascular treatment and radiosurgery this kind of DAVF must be surgically treated. The operation may be complex and dangerous.
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Affiliation(s)
- Ettore Fiumara
- Department of Neurosurgery, Villa Sofia Hospital, Palermo, Italy.
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Klisch J, Huppertz HJ, Spetzger U, Hetzel A, Seeger W, Schumacher M. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature. Neurosurgery 2003; 53:836-56; discussion 856-7. [PMID: 14519216 DOI: 10.1227/01.neu.0000083551.26295.ab] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2002] [Accepted: 06/04/2003] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches. METHODS Retrospective analysis of data for 31 patients (age range, 17-81 yr; mean age, 59.3 yr) with carotid cavernous fistulae (n = 6) or dural AVFs (cavernous sinus [CS], n = 11; transverse/sigmoid sinus, n = 14) was performed. The AVFs were treated with coils via different transvenous approaches, in 56 procedures. Doppler ultrasonography and time-resolved, two-dimensional, magnetic resonance projection angiography were performed to confirm the treatment. The mean clinical follow-up period was 32.5 months. RESULTS A total of 34 transvenous procedures were performed for 17 AVFs of the CS. Eleven patients with AVFs of the CS (63%) were cured with respect to clinical symptoms, and six patients experienced improvement (37%). The approach via the internal jugular vein and inferior petrosal sinus (n = 15) was possible in 60% of cases, with complete occlusion of the fistula in 78% of cases. With the approach via the facial vein (n = 8), there was a 50% success rate. The superior ophthalmic vein approach (n = 5) was associated with a high rate of technical success (100%), with a rate of complete fistula occlusion of 80%. We encountered complications, with transient morbidity, in four cases (23.5%). For 14 dural AVFs of the transverse/sigmoid sinus, 22 transvenous procedures were performed; 12 patients were cured (85.7%) and 2 experienced improvement (14.3%). The technical success rate was 86%, with complete occlusion in 42% of cases. Minor complications occurred in six cases (42.9%) but did not lead to permanent morbidity. CONCLUSION Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.
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Affiliation(s)
- Joachim Klisch
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
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Russell SM, Woo HH, Nelson PK. Transarterial Wedged-catheter, Flow-arrest, N-butyl Cyanoacrylate Embolization of Three Dural Arteriovenous Fistulae in a Single Patient. Interv Neuroradiol 2003; 9:283-90. [PMID: 20591254 DOI: 10.1177/159101990300900307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Accepted: 03/20/2003] [Indexed: 11/17/2022] Open
Abstract
SUMMARY The pathogenesis of dural arteriovenous fistulas (DAVFs) is currently unknown, with multiple DAVFs being rare. For patients with limited venous access secondary to sinus thrombosis, or for patients where parent sinus occlusion would not be tolerated, transvenous embolization may not be possible and other treatment methods must be considered. A 69-year-old female patient with a two-year history of progressive headaches, memory loss, and unsteady gait underwent cerebral angiography that revealed three separate DAVFs with congested cortical venous drainage overlying both frontal lobes. Using an application of a transarterial wedged-catheter, flow-arrest technique, N-butyl cyanoacrylate was deposited across all three pathologic arteriovenous connections providing a definitive cure. Transarterial NBCA embolization may provide curative treatment of DAVFs, and is of particular utility in situations where access to the draining venous structures is limited.
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Affiliation(s)
- S M Russell
- Neurointerventional Service; Department of Neurosurgery, New York University School of Medicine; New York, USA -
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