Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas Presenting with Intracranial Hemorrhage in 46 Consecutive Patients: With Emphasis on Transarterial Embolization with Onyx

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

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Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

Journal of Neurosurgery ◽

10.3171/2010.8.gks10977 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 21-27 ◽

Cited By ~ 5

Author(s):

Hyun Ho Jung ◽

Jong Hee Chang ◽

Kum Whang ◽

Jin Soo Pyen ◽

Jin Woo Chang ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Transarterial Embolization ◽

Gamma Knife Surgery ◽

Low Flow ◽

Close Monitoring ◽

Arteriovenous Fistulas ◽

Ocular Symptoms ◽

Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

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Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3)

Journal of Neurosurgery ◽

10.3171/2019.4.jns183458 ◽

2020 ◽

Vol 133 (1) ◽

pp. 166-173 ◽

Cited By ~ 4

Author(s):

Masafumi Hiramatsu ◽

Kenji Sugiu ◽

Tomohito Hishikawa ◽

Shingo Nishihiro ◽

Naoya Kidani ◽

...

Keyword(s):

Risk Factors ◽

Data Extraction ◽

Transarterial Embolization ◽

Complication Rates ◽

Multicenter Observational Study ◽

Arteriovenous Fistulas ◽

Emergency Procedures ◽

Dural Arteriovenous Fistulas ◽

Nature Frequency ◽

Independent Risk Factors

OBJECTIVEEmbolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization.METHODSPatient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization.RESULTSTransarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non–sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications.CONCLUSIONSComplication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.

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Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas

Surgery for Cerebral Stroke ◽

10.2335/scs.38.235 ◽

2010 ◽

Vol 38 (4) ◽

pp. 235-242 ◽

Cited By ~ 1

Author(s):

Naoko MIYAMOTO ◽

Isao NAITO ◽

Shin TAKATAMA ◽

Tomoyuki IWAI ◽

Masahiro MATSUMOTO ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein

Journal of Neurosurgery ◽

10.3171/jns.2006.105.4.636 ◽

2006 ◽

Vol 105 (4) ◽

pp. 636-639 ◽

Cited By ~ 20

Author(s):

Dennis J. Rivet ◽

James K. Goddard ◽

Keith M. Rich ◽

Colin P. Derdeyn

Keyword(s):

Endovascular Treatment ◽

Transverse Sinus ◽

Dural Sinus ◽

Type Ii ◽

Emissary Vein ◽

Arteriovenous Fistulas ◽

Mastoid Emissary Vein ◽

Vein Access ◽

Dural Arteriovenous Fistulas ◽

Gain Access

✓ Definitive endovascular treatment of dural arteriovenous fistulas (DAVFs) requires obliteration of the site of the fistula: either the diseased dural sinus or the pial vein. Access to this site is often limited by occlusion of the sinus proximal and distal to the segment containing the fistula. The authors describe a technique in which the mastoid emissary vein is used to gain access to a Borden–Shucart Type II DAVF in the transverse–sigmoid sinus. Recognition of this route of access, if present, may facilitate endovascular treatment of these lesions. Access to the transverse sinus via this approach can be straightforward and may be underused.

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