Incidental Ethmoidal Dural Arteriovenous Fistula

2019 ◽  
pp. 233-240
Author(s):  
Ilyas Eli ◽  
Robert Kim ◽  
Richard H. Schmidt ◽  
Philipp Taussky ◽  
William T. Couldwell
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
High Rate ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Ethmoidal Artery ◽  
Cranial Fossa ◽  
Cortical Venous Drainage ◽  
Management Alternatives ◽  
Low Rate

Abstract: Anterior cranial fossa (ethmoidal) dural arteriovenous fistulas are an important subtype of cranial dural arteriovenous fistulas. These fistulas transit the skull base between the ethmoidal artery feeding branch and the anterior inferior frontal lobe. They are most often considered high risk fistulas. Because of their location and almost exclusively cortical venous drainage, they often present with hemorrhage. Surgical clipping and resection is the mainstay of treatment, with a high rate of effectiveness and a low rate of complications. However, in certain cases, transarterial and transvenous embolization have emerged as important management alternatives. This chapter discusses the diagnosis and management of ethmoidal dural arteriovenous fistulas.

scholarly journals Bifrontal approach for clip ligation of bilateral ethmoidal dural arteriovenous fistulas: operative video

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V14 ◽  
Author(s):  
Tyler S. Cole ◽  
Sirin Gandhi ◽  
Justin R. Mascitelli ◽  
Douglas Hardesty ◽  
Claudio Cavallo ◽  
...  
Keyword(s):  
Natural History ◽  
Gold Standard ◽  
Dural Arteriovenous Fistula ◽  
Standard Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Surgical Clip ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

Venous interruption through surgical clip ligation is the gold standard treatment for ethmoidal dural arteriovenous fistula (e-dAVF). Their malignant natural history is attributable to the higher predilection for retrograde cortical venous drainage. This video illustrates an e-dAVF in a 70-year-old man with progressive tinnitus and headache. Angiogram revealed bilateral e-dAVFs (Borden III–Cognard III) with one fistula draining into cavernous sinus and another to the sagittal sinus. A bifrontal craniotomy was utilized for venous interruption of both e-dAVFs. Postoperative angiography confirmed curative obliteration with no postoperative anosmia. Bilateral e-dAVFs are rare but can be safely treated simultaneously through a single craniotomy.The video can be found here: https://youtu.be/666edwKHGKc.

Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)

2021 ◽  
pp. 1-9
Author(s):  
Isaac Josh Abecassis ◽  
R. Michael Meyer ◽  
Michael R. Levitt ◽  
Jason P. Sheehan ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Risk Factors For Recurrence ◽  
Cortical Venous Drainage

OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases). RESULTS Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision). CONCLUSIONS Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

Embolization of anterior cranial fossa dural arteriovenous fistula

2019 ◽  
Vol 1 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Bazli Md Yusoff ◽  
Ahmad Aizuddin Mohamad Jamali ◽  
Mohd Syafiek Abdul Haq Saifuddin ◽  
Mohd Shafie Abdullah ◽  
Abdul Rahman Izaini Ghani
Keyword(s):  
Case Report ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Anterior Cranial Fossa ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Cranial Fossa ◽  
Intracranial Arteries

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

Embolization of anterior cranial fossa dural arteriovenous fistula

2019 ◽  
pp. 8-10
Author(s):  
Bazli Md Yusoff ◽  
Ahmad Aizuddin Mohamad Jamali ◽  
Mohd Syafiek Abdul Haq Saifuddin ◽  
Mohd Shafie Abdullah ◽  
Abdul Rahman Izaini Ghani
Keyword(s):  
Case Report ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Anterior Cranial Fossa ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Cranial Fossa ◽  
Intracranial Arteries

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

scholarly journals Endovascular management of complex superior sagittal sinus dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V11
Author(s):  
André Beer-Furlan ◽  
Krishna C. Joshi ◽  
Hormuzdiyar H. Dasenbrock ◽  
Michael Chen
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Transvenous Approach

Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are rare and present unique challenges to treatment. Complex, often bilateral, arterial supply and involvement of large volumes of eloquent cortical venous drainage may necessitate multimodality therapy such as endovascular, microsurgical, and stereotactic radiosurgery techniques. The authors present a complex SSS DAVF associated with an occluded/severely stenotic SSS. The patient underwent a successful endovascular transvenous approach with complete obliteration of the SSS. The authors discuss the management challenges faced on this case.The video can be found here: https://youtu.be/-rztg0_cBXY.

scholarly journals Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 127-134 ◽  
Author(s):  
T. Kawaguchi ◽  
M. Nakatani ◽  
T. Kawano
Keyword(s):  
Emergency Treatment ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Sigmoid Sinus ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

scholarly journals Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

2015 ◽  
Vol 21 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Yongxin Zhang ◽  
Qiang Li ◽  
Qing-hai Huang
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Therapeutic Option ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Balloon Protection

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

2012 ◽  
Vol 32 (5) ◽  
pp. E10 ◽  
Author(s):  
Charles Kulwin ◽  
Bradley N. Bohnstedt ◽  
John A. Scott ◽  
Aaron Cohen-Gadol
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Rare Entity ◽  
Arteriovenous Fistulas ◽  
Drainage Patterns ◽  
Clinical Presentations ◽  
Wide Range ◽  
Brainstem Dysfunction ◽  
Dural Arteriovenous Fistulas

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

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