Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

Abstract Purpose This study aims to determine local diagnostic reference levels (DRLs) in the endovascular therapy (EVT) of patients with cranial and spinal dural arteriovenous fistula (dAVF). Methods In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients with cranial and spinal dAVF undergoing EVT (I) or diagnostic angiography (II). All procedures were performed at the flat-panel angiography-system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the region of fistula and the type of procedure. Results In total, 264 neurointerventional procedures of 131 patients with dAVF (94 cranial, 37 spinal) were executed between 02/2010 and 12/2020. The following DRLs, AD, and mean values could be determined: for cranial dAVF (I) DRL 507.33 Gy cm2, AD 369.79 Gy cm2, mean 396.51 Gy cm2; (II) DRL 256.65 Gy cm2, AD 214.19 Gy cm2, mean 211.80 Gy cm2; for spinal dAVF (I) DRL 482.72 Gy cm2, AD 275.98 Gy cm2, mean 347.12 Gy cm2; (II) DRL 396.39 Gy cm2, AD 210.57 Gy cm2, mean 299.55 Gy cm2. Dose levels of EVT were significantly higher compared to diagnostic angiographies (p < 0.001). No statistical difference in dose levels regarding the localization of dAVF was found. Conclusion Our results could be used for establishing DRLs in the EVT of cranial and spinal dAVF. Because radiation exposure to comparably complex interventions such as AVM embolization is similar, it may be useful to determine general DRLs for both entities together.

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Radiation Exposure During Diagnostic and Therapeutic Angiography of Carotid-cavernous Fistula

Clinical Neuroradiology ◽

10.1007/s00062-021-01126-x ◽

2021 ◽

Author(s):

Marcel Opitz ◽

Georgios Alatzides ◽

Sebastian Zensen ◽

Denise Bos ◽

Axel Wetter ◽

...

Keyword(s):

Philips Healthcare ◽

Carotid Cavernous Fistula ◽

Flat Panel ◽

Mean Values ◽

Diagnostic Angiography ◽

Retrospective Study Design ◽

Carotid Cavernous Fistulas ◽

Dose Levels ◽

Neurointerventional Procedures ◽

Dose Difference

Abstract Purpose The aim of this study was to determine local diagnostic reference levels (DRLs) during endovascular diagnostics and therapy of carotid-cavernous fistulas (CCF). Methods In a retrospective study design, DRLs, achievable dose (AD) and mean values were assessed for all patients with CCF undergoing diagnostic angiography (I) or embolization (II). All procedures were performed with the flat-panel angiography system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the type of CCF and the type of procedure. Results In total, 86 neurointerventional procedures of 48 patients with CCF were executed between February 2010 and July 2021. The following DRLs, AD and mean values could be determined: (I) DRL 215 Gy ∙ cm2, AD 169 Gy ∙ cm2, mean 165 Gy ∙ cm2; (II) DRL 350 Gy ∙ cm2, AD 226 Gy ∙ cm2, mean 266 Gy ∙ cm2. Dose levels of embolization were significantly higher compared to diagnostic angiography (p < 0.001). No significant dose difference was observed with respect to the type of fistula or the embolization method. Conclusion This article reports on diagnostic and therapeutic DRLs in the management of CCF that could serve as a benchmark for the national radiation protection authorities. Differentiation by fistula type or embolization method does not seem to be useful.

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Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.75 ◽

2018 ◽

Vol 1 (2) ◽

Author(s):

Nur Setiawan Suroto

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Vascular Malformation ◽

Dural Arteriovenous Fistula ◽

Motor Symptoms ◽

Elderly Men ◽

Spinal Dural Arteriovenous Fistula ◽

Sensory Disturbances ◽

Av Fistulas ◽

Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

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Letter to the Editor Regarding “Spinal Dural Arteriovenous Fistula: Diagnosis, Outcomes, and Prognostic Factors”

World Neurosurgery ◽

10.1016/j.wneu.2021.01.065 ◽

2021 ◽

Vol 149 ◽

pp. 307-308

Author(s):

Bo-An Chen ◽

Jui-Feng Lin ◽

Wei-Ming Huang

Keyword(s):

Prognostic Factors ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Letter To The Editor

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Metachronous Spinal Dural Arteriovenous Fistula: Case Report And Review Of Literature On Implications For Pathophysiology And Management

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101181 ◽

2021 ◽

pp. 101181

Author(s):

Barton Waser ◽

Heath French ◽

Shivendra Lalloo ◽

Peter Mews

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Review Of Literature ◽

Spinal Dural Arteriovenous Fistula

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Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012267 ◽

2016 ◽

Vol 9 (4) ◽

pp. 405-410 ◽

Cited By ~ 10

Author(s):

Yudhi Adrianto ◽

Ku Hyun Yang ◽

Hae-Won Koo ◽

Wonhyoung Park ◽

Sung Chul Jung ◽

...

Keyword(s):

Clinical Outcome ◽

Arteriovenous Fistula ◽

Open Surgery ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Posterior Spinal Artery ◽

Lumbar Level ◽

Scale Scores ◽

Complete Obliteration ◽

Endovascular Approach

Background/objectiveThe concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.MethodsIn 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsNine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.ConclusionsThe concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

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Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012497 ◽

2016 ◽

Vol 9 (2) ◽

pp. 178-182 ◽

Cited By ~ 6

Author(s):

Santhosh Kumar Kannath ◽

Bejoy Thomas ◽

P Sankara Sarma ◽

Jayadevan Enakshy Rajan

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Definitive Treatment ◽

Spinal Angiography ◽

Vertebral Level ◽

Spinal Dural Arteriovenous Fistula ◽

Historical Cohort ◽

Contrast Enhanced ◽

The Impact

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

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