scholarly journals Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Andrea M. Alexandre ◽  
Carmelo Lucio Sturiale ◽  
Andrea Bartolo ◽  
Andrea Romi ◽  
Alba Scerrati ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Meta Analysis ◽  
Complication Rates ◽  
Arteriovenous Fistulas ◽  
First Line Therapy ◽  
Ovid Medline ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas

Abstract Purpose Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 88-92
Author(s):  
N. Kuwayama ◽  
S. Endo ◽  
M. Kubo ◽  
T. Akai ◽  
A. Takaku
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Dural Arteriovenous Fistulas ◽  
The Right

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.

scholarly journals Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

2020 ◽  
Vol 10 (2) ◽  
pp. 84-93
Author(s):  
Volker Maus ◽  
Finn Drescher ◽  
Lukas Goertz ◽  
Anushe Weber ◽  
Werner Weber ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Success ◽  
Embolic Agent ◽  
Common Symptom ◽  
Arteriovenous Fistulas ◽  
Patient Demographics ◽  
Single Center Experience ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Reflux

Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.

Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18

2008 ◽  
Vol 109 (6) ◽  
pp. 1083-1090 ◽  
Author(s):  
Xianli Lv ◽  
Chuhan Jiang ◽  
Youxiang Li ◽  
Zhongxue Wu
Keyword(s):  
Transarterial Embolization ◽  
Clinical Status ◽  
Complication Rates ◽  
Trigeminocardiac Reflex ◽  
Arteriovenous Fistulas ◽  
Liquid Embolic ◽  
Definitive Therapy ◽  
Dural Arteriovenous Fistulas ◽  
Scale Scores

Object Use of the Onyx liquid embolic system has become an option for treating dural arteriovenous fistulas (DAVFs) because of its advantageous nonadhesive and cohesive properties. However, the complication rates associated with the use of this system have not been reported. The authors present their initial experience of the risks related to transarterial embolization using this system. Methods Between February 2005 and February 2007, 31 patients with DAVFs were treated at Beijing Tiantan Hospital. Transarterial embolization using Onyx-18 was performed as a preoperative adjunct or as definitive therapy. The demographic characteristics, angiographic features, clinical presentation, treatment, and outcome of the patients were reviewed. Clinical follow-up status was supplemented by telephone interviews to determine Glasgow Outcome Scale scores. Results In 19 patients (61.3%) there was complete angiographic evidence of elimination of the shunts and resolution of the symptoms. The remaining 12 patients were treated successfully but did not attain complete embolization and had residual shunting. Adverse events occurred in 5 of 31 patients, with 3 DAVFs located at the tentorium, 1 at the inferior petrosal sinus, and 1 at the cavernous sinus. Complications included trigeminocardiac reflex in 2 patients (6.5%), hemifacial hypesthesia in 3 patients (9.7%), hemifacial palsy in 2 patients (6.5%), jaw pain in 1 patient (3.2%), posterior fossa infarction in 1 patient (3.2%), and microcatheter gluing in 1 patient (3.2%). At the last follow-up examination, all patients had returned to an independent clinical status. Conclusions Although a complete resolution of symptoms can be achieved with transarterial embolization using the Onyx liquid embolic system, the potential for serious complications exists with this procedure, necessitating the participation of a skilled neurointerventionalist.

scholarly journals Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

2014 ◽  
Vol 27 (4) ◽  
pp. 461-470 ◽  
Author(s):  
Ali Pashapour ◽  
Reza Mohammadian ◽  
Firooz Salehpour ◽  
Ehsan Sharifipour ◽  
Reza Mansourizade ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis

2014 ◽  
Vol 8 (3) ◽  
pp. 265-272 ◽  
Author(s):  
Abdussalam Elsenousi ◽  
Victor A Aletich ◽  
Ali Alaraj
Keyword(s):  
Arteriovenous Malformations ◽  
Meta Analysis ◽  
Endovascular Embolization ◽  
Complication Rates ◽  
Cure Rate ◽  
Ethylene Vinyl Alcohol ◽  
Neurological Outcomes ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Cure Rates

BackgroundIn the past decade, preoperative endovascular embolization of cerebral arteriovenous malformations (AVMs) became an essential tool in the treatment of these entities. With the current expansion of technology and wide incorporation of new devices, the indications for the use of endovascular embolization have expanded to include embolization for cure. This has been facilitated by the wide use of the new liquid embolic agents (ethylene-vinyl alcohol co-polymer (EVOH)) in addition to n-butyl cyanoacrylate (NBCA). The aim of this study was to review the current published literature for these two agents and report on permanent neurological injuries and cure rate.MethodsPublished literature citing embolization results for AVMs using liquid embolic agents was reviewed. Papers reporting on permanent complication rates and complete angiographic cure were reviewed. A meta-analysis was performed based on these two variables for the two embolic agents.Results103 studies met the selection criteria. Poor neurological outcomes for NBCA and EVOH were 5.2% and 6.8%, respectively (OR 1.4; p=0.56). AVM complete obliteration rate was seen in 13.7% in the NBCA group and in 24% in the EVOH group (OR 1.9). This OR decreased to 1.35 in the subgroup analysis for patients treated after the year 2000.ConclusionsNBCA continues to have a trend towards lower permanent complication rates, but EVOH had higher angiographic cure rates. The recent literature has demonstrated an increase in the cure rate of AVMs with endovascular embolization techniques yet with a possible increase in permanent neurological deficits and mortality.

Evaluation of dural arteriovenous fistulas of cavernous sinus before and after endovascular treatment using time-resolved MR angiography

2010 ◽  
Vol 33 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Shigeyuki Sakamoto ◽  
Masaaki Shibukawa ◽  
Yoshihiro Kiura ◽  
Toshinori Matsushige ◽  
Nobukazu Abe ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Mr Angiography ◽  
Time Resolved ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Before And After

scholarly journals Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

2020 ◽  
Vol 26 (5) ◽  
pp. 651-657
Author(s):  
Emilio Lozupone ◽  
Sandra Bracco ◽  
Pietro Trombatore ◽  
Luca Milonia ◽  
Francesco D’Argento ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
High Rate ◽  
Embolic Agent ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Clinical Complications ◽  
Lower Viscosity ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas

Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.

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