Direct transforaminal Onyx embolization of intracranial dural arteriovenous fistulas: technical note and report of five cases

2013 ◽  
Vol 6 (7) ◽  
pp. 500-504 ◽  
Author(s):  
Pedro Saura ◽  
Javier Saura ◽  
Antonio Pérez-Higueras ◽  
Mario Martínez-Galdámez
Keyword(s):  
Technical Note ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

scholarly journals Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note

2019 ◽  
Vol 12 (3) ◽  
pp. e014834
Author(s):  
Emanuele Orru ◽  
Chun On Anderson Tsang ◽  
Jesse M Klostranec ◽  
Vitor M Pereira
Keyword(s):  
Internal Iliac Artery ◽  
Tethered Cord ◽  
Common Femoral Artery ◽  
Technical Note ◽  
Femoral Access ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Diagnostic Angiography ◽  
Internal Iliac ◽  
Full Neurological Recovery

Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.

scholarly journals Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

2016 ◽  
Vol 25 (3) ◽  
pp. 394-397 ◽  
Author(s):  
Chen Wang ◽  
Chien-Min Chen ◽  
Fang Shen ◽  
Xiao-Dong Fang ◽  
Guang-Yu Ying ◽  
...  
Keyword(s):  
Technical Note ◽  
Endoscopic Management ◽  
Short Term ◽  
Endoscopic Techniques ◽  
Arteriovenous Fistulas ◽  
Interlaminar Approach ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

Three-Dimensional Endoscopic Magnification for Treatment of Thoracic Spinal Dural Arteriovenous Fistulas: Technical Note

2017 ◽  
Vol 14 (3) ◽  
pp. 259-266
Author(s):  
Alexander G Weil ◽  
Sami Obaid ◽  
Chiraz Chaalala ◽  
Daniel Shedid ◽  
Elsa Magro ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Technical Note ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
Tunnel Vision ◽  
Thoracic Spinal ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of “tunnel vision” with reduced luminosity to a remote surgical target. OBJECTIVE To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs. METHODS We present 2 cases of symptomatic thoracic DAVFs that were not amenable to endovascular treatment. The DAVFs were excluded solely via a minimally invasive approach using a 3-D endoscope. RESULTS Two patients underwent exclusion of a DAVF following laminotomy, one through a midline 5-cm incision and the other through a paramedian 3-cm incision using minimally invasive nonexpandable tubular retractors. The dura opening, intradural exploration, fistula exclusion, and closure were performed solely under endoscopic 3-D magnification. No incidents were recorded and the postoperative course was marked by clinical improvement. Postoperative imaging confirmed the exclusion of the DAVFs. Anatomical details are exposed using intraoperative videos. CONCLUSION When approaching DAVFs via MISS, replacing the microscope with the endoscope remedies the limitations related to the “tunnel vision” created by the tubular retractor, but at the expense of losing binocular vision. We show that the 3-D endoscope resolves this latter limitation and provides an interesting option for the exclusion of spinal DAVFs.

scholarly journals Republished: Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note

2019 ◽  
Vol 11 (8) ◽  
pp. e4-e4 ◽  
Author(s):  
Emanuele Orru ◽  
Chun On Anderson Tsang ◽  
Jesse M Klostranec ◽  
Vitor M Pereira
Keyword(s):  
Internal Iliac Artery ◽  
Tethered Cord ◽  
Common Femoral Artery ◽  
Technical Note ◽  
Femoral Access ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Diagnostic Angiography ◽  
Internal Iliac ◽  
Full Neurological Recovery

Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.

Preliminary experience with the liquid embolic material agent PHIL (Precipitating Hydrophobic Injectable Liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note

2015 ◽  
Vol 8 (6) ◽  
pp. 596-602 ◽  
Author(s):  
Joe J Leyon ◽  
Swarupsinh Chavda ◽  
Allan Thomas ◽  
Saleh Lamin
Keyword(s):  
Interventional Neuroradiology ◽  
Technical Note ◽  
Embolic Agent ◽  
Embolic Material ◽  
Arteriovenous Fistulas ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas ◽  
Fluoroscopic Time ◽  
Liquid Embolic Agent

BackgroundLiquid embolic agents are the preferred embolic material in endovascular treatment of pial and brain arteriovenous malformations and dural arteriovenous fistulas (DAVFs). There is little choice available in interventional neuroradiology practice other than two of the most commonly used liquid embolic agents—n-butyl cyanoacrylate and the Onyx liquid embolic system (ev3 Neurovascular, Irvine, California, USA). PHIL (Precipitating Hydrophobic Injectable Liquid) (Microvention, Inc California, USA) is a new liquid embolic agent, CE marked and available for clinical use in Europe.ObjectiveTo present our preliminary experience using PHIL in treating cranial and spinal DAVFs.MethodsBetween September 2014 and January 2015, eight patients, with five cranial DAVFs and three spinal DAVFs were treated with PHIL as the sole embolic agent used with intent to cure. Clinical presentation, location of DAVF, Borden type, fluoroscopic time, radiation dose, procedural time, injecting microcatheter used, volume of PHIL injected, complications, immediate angiographic data, premorbid and discharge modified Rankin Scale score, and any neurologic deficits were included in the analysis.ResultsSeven patients were successfully treated with complete angiographic exclusion of the fistula in a single sitting. Treatment failed in one patient where only suboptimal microcatheter positioning could be achieved and PHIL failed to penetrate the fistula's nidus. Venous penetration was achieved in all other patients except one with a small fistula, but with adequate fistula penetration by the embolic material. No other technical complication or neurologic deterioration occurred in any of the patients.ConclusionsPHIL liquid embolic agent appears to be an excellent alternative embolic material with certain advantages compared with other available liquid embolic agents. Further studies are required to fully evaluate its safety and efficacy.

Surgical Management of Transosseous Dural Arteriovenous Fistulas in the Region of the Jugular Foramen

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Wuttipong Tirakotai ◽  
C. Kappus ◽  
B. Krischek ◽  
U. Sure ◽  
H. Bertalanffy
Keyword(s):  
Surgical Management ◽  
Jugular Foramen ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

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

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 21-27 ◽  
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.

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

2020 ◽  
Vol 133 (1) ◽  
pp. 166-173 ◽  
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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