E-043 High-Grade Dural Arteriovenous Fistula Causing Subarachnoid Haemorrhage with Direct Visualization of the Rupture Site on CT Angiography

2014 ◽  
Vol 6 (Suppl 1) ◽  
pp. A57.2-A58
Author(s):  
V Daruwalla ◽  
B Patel ◽  
A Honarmand ◽  
S Sherazi ◽  
S Ansari ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Dural Arteriovenous Fistula ◽  
High Grade ◽  
Direct Visualization ◽  
Rupture Site

Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study

2021 ◽  
pp. 1-9
Author(s):  
Ching-Jen Chen ◽  
Thomas J. Buell ◽  
Dale Ding ◽  
Ridhima Guniganti ◽  
Akash P. Kansagra ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Intervention Group ◽  
Group Versus ◽  
Symptomatic Improvement ◽  
High Grade ◽  
Type Ii ◽  
Risk Of Death ◽  
All Cause Mortality

OBJECTIVE The risk-to-benefit profile of treating an unruptured high-grade dural arteriovenous fistula (dAVF) is not clearly defined. The aim of this multicenter retrospective cohort study was to compare the outcomes of different interventions with observation for unruptured high-grade dAVFs. METHODS The authors retrospectively reviewed dAVF patients from 12 institutions participating in the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). Patients with unruptured high-grade (Borden type II or III) dAVFs were included and categorized into four groups (observation, embolization, surgery, and stereotactic radiosurgery [SRS]) based on the initial management. The primary outcome was defined as the modified Rankin Scale (mRS) score at final follow-up. Secondary outcomes were good outcome (mRS scores 0–2) at final follow-up, symptomatic improvement, all-cause mortality, and dAVF obliteration. The outcomes of each intervention group were compared against those of the observation group as a reference, with adjustment for differences in baseline characteristics. RESULTS The study included 415 dAVF patients, accounting for 29, 324, 43, and 19 in the observation, embolization, surgery, and SRS groups, respectively. The mean radiological and clinical follow-up durations were 21 and 25 months, respectively. Functional outcomes were similar for embolization, surgery, and SRS compared with observation. With observation as a reference, obliteration rates were higher after embolization (adjusted OR [aOR] 7.147, p = 0.010) and surgery (aOR 33.803, p < 0.001) and all-cause mortality was lower after embolization (imputed, aOR 0.171, p = 0.040). Hemorrhage rates per 1000 patient-years were 101 for observation versus 9, 22, and 0 for embolization (p = 0.022), surgery (p = 0.245), and SRS (p = 0.077), respectively. Nonhemorrhagic neurological deficit rates were similar between each intervention group versus observation. CONCLUSIONS Embolization and surgery for unruptured high-grade dAVFs afforded a greater likelihood of obliteration than did observation. Embolization also reduced the risk of death and dAVF-associated hemorrhage compared with conservative management over a modest follow-up period. These findings support embolization as the first-line treatment of choice for appropriately selected unruptured Borden type II and III dAVFs.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

scholarly journals WITHDRAWN: Trans-arterial CT angiography for surgical planning of spinal dural arteriovenous fistula

2020 ◽  
pp. 100715
Author(s):  
Saminderjit Kular ◽  
George Tse ◽  
Alexandru Budu ◽  
Andrew Bacon ◽  
Kishor A. Choudhari ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Surgical Planning ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula

scholarly journals Intracranial dural arteriovenous fistula and perimesencephalic subarachnoid haemorrhage. A case study

2020 ◽  
Vol 35 (7) ◽  
pp. 514-515
Author(s):  
D. Páez-Granda ◽  
G. Parrilla ◽  
M. Espinosa de Rueda ◽  
J.D. Berná-Serna
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula

scholarly journals Management of a rare case of posterior condylar canal dural arteriovenous fistula presenting with subarachnoid haemorrhage: A case report and review of literature

2017 ◽  
Vol 24 (2) ◽  
pp. 206-209 ◽  
Author(s):  
Somorendra Singh Shambanduram ◽  
Leve Joseph Devarajan Sebastian ◽  
Nishchint Jain ◽  
Ajay Garg ◽  
Shailesh B Gaikwad
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
English Literature ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Left Vertebral Artery ◽  
Endovascular Management ◽  
Posterior Condylar ◽  
Bridging Vein

Posterior condylar canal dural arteriovenous fistula (PCC dAVF) is a rare entity with only three cases having been reported so far in the English literature. We describe the clinical presentation, imaging, and endovascular management of an elderly man with left PCC dAVF presenting with subarachnoid haemorrhage (SAH). Endovascular management of such cases requires thorough understanding of the vascular anatomy around the craniovertebral junction (CVJ) and variable bridging vein draining patterns. The fistula in our case was fed by the posterior meningeal branch of the left vertebral artery and was draining through a dilated and tortuous medullary bridging vein into the antero-lateral pontomedullary venous system. Transarterial glue embolisation was performed with complete exclusion of the fistula and venous pouches. The patient developed intractable hiccough and left-sided facial pain on the second post-procedural day, and MRI showed focal diffusion restriction in the left dorso-lateral medulla. He recovered completely after a short course of steroids.

Angiographically occult spinal dural arteriovenous fistula located using selective computed tomography angiography

2007 ◽  
Vol 7 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Taku Sugawara ◽  
Yoshitaka Hirano ◽  
Yasunobu Itoh ◽  
Hiroyuki Kinouchi ◽  
Satoshi Takahashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Cord ◽  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Dural Arteriovenous Fistula ◽  
Low Flow ◽  
Spinal Dural Arteriovenous Fistula ◽  
Coronary Veins ◽  
Spinal Arteriovenous Malformation

✓Spinal dural arteriovenous fistula (DAVF) is the most common type of spinal arteriovenous malformation and may cause progressive myelopathy but is usually treatable in the early stages by direct surgery or intravascular embolization. Selective spinal angiography has been the gold standard for diagnosis, but angiographically occult DAVF is not uncommon. A 67-year-old man presented with a 2-year history of progressive paraparesis. Magnetic resonance (MR) imaging demonstrated segmental atrophy of the spinal cord and dilated coronary veins on the dorsal surface of the spinal cord. A DAVF was suspected, but repeated selective angiography failed to demonstrate the fistula. Findings from spoiled gradient echo MR imaging suggested that the draining vein flowed into the dilated venous plexus at the T-9 level. Selective computed tomography (CT) angiography of the right T-9 intercostal artery confirmed the location of the fistula. The authors successfully occluded the draining vein through surgery, and they observed that the fistula was low flow. The patient exhibited improvement in his symptoms, and postoperative MR imaging confirmed closure of the fistula. Selective CT angiography is useful in locating the draining vein of angiographically occult DAVF and therefore minimizing the extent of the surgical procedure.

scholarly journals Computed tomography (CT) angiography with multidetector row helical CT for detecting spinal dural arteriovenous fistula

2008 ◽  
Vol 48 (3) ◽  
pp. 205-207 ◽  
Author(s):  
Hiroshi Kobessho ◽  
Shigeru Mitsui ◽  
Hiroyuki Ishihara ◽  
Masahiko Fujii ◽  
Ryota Kawasaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Dural Arteriovenous Fistula ◽  
Helical Ct ◽  
Spinal Dural Arteriovenous Fistula ◽  
Multidetector Row

Engorged medullary vein on CT angiography in patients with dural arteriovenous fistula: prevalence, types, and comparison between regional and extensive types

2018 ◽  
Vol 10 (11) ◽  
pp. 1114-1119
Author(s):  
Yen-Heng Lin ◽  
Chung-Wei Lee ◽  
Yu-Fen Wang ◽  
Chi-Ju Lu ◽  
Ya-Fang Chen ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Cerebral Hemisphere ◽  
Dural Arteriovenous Fistula ◽  
Clinical Presentation ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Clinical Information ◽  
Clinical Findings ◽  
Cerebral White Matter

Background and purposeEngorged medullary vein (EMV) in patients with intracranial dural arteriovenous fistula (DAVF) suggests venous congestion. The aim of this study is to investigate its prevalence, pattern, and correlation with clinical findings.Materials and methodsCT angiography (CTA) raw data of DAVF were used for multiplanar reconstruction and then analyzed for the presence and pattern of EMV, which is defined as a dilated vein in the cerebral white matter. Patients with EMV were divided into two groups: regional and extensive. Regional type is defined as EMV limited to one cerebral hemisphere or cerebellum without evidence of subcortical calcification. Extensive type is defined as EMV involvement of more than one cerebral hemisphere or both the cerebrum and cerebellum. Descriptive analysis of clinical information, DAVF characteristics, and other imaging findings was conducted. Clinical information, including demographic data, clinical presentation, and hemorrhage, were correlated with both types of EMV.ResultsAmong 192 eligible patients with DAVF, 71 (37%) had EMV. Patients with EMV were older (63 years vs 56 years, P=0.02), with DAVF more often at the transverse and sigmoid sinus (P<0.001), and more often presented with aggressive symptoms (59% vs 34%, P=0.02) than non-EMV patients, but there was no difference in the presentation of hemorrhage (15% vs 16%, P=0.99). Patients with regional EMV had a higher proportion of hemorrhage than those with the extensive type (24% vs 0%, P=0.006).ConclusionsEMV in patients with DAVF is associated with an aggressive manifestation. Regional type EMV is associated with a higher risk of a hemorrhagic presentation.

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