P-032 clinical presentation and outcomes of non-cavernous dural arteriovenous fistulas undergoing endovascular therapy as primary treatment modality

Abstract Background Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. We hypothesize that there may be subtypes of dAVFs responding better to a specific treatment modality in terms of successful obliteration and cessation of symptoms and/or risks. Methods All dAVFs treated during 2011–2018 at our hospital were analyzed retrospectively. Presenting symptoms, radiological variables, treatment modality, complications, and residual symptoms were related to dAVF type using the original Djindjian classification. Results We treated 112 dAVFs in 107 patients (71, 66% males). They presented with hemorrhage (n = 23; 21%), non-hemorrhagic symptoms (n = 75; 70%), or were discovered incidentally (n = 9; 8%). There were 25 (22%) type I, 29 (26%) type II, 26 (23%) type III, and 32 (29%) type IV fistulas. EVT was the primary treatment modality in 72/112 (64%) dAVFs whereas 40/112 (36%) underwent primary surgery with angiographic obliteration rates of 60% and 90%, respectively. Using a secondary treatment modality in 23 dAVFs, we obtained a final obliteration rate of 93%, including all type III/IV and 26/27 (96%) type II dAVFs. Except for headache, residual symptoms were rare and minor. Permanent neurological complications consisted of five cranial nerve deficits. Conclusions We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk.

Download Full-text

Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

Case Reports in Neurological Medicine ◽

10.1155/2012/345830 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Toba N. Niazi ◽

Christian A. Bowers ◽

Meic H. Schmidt

Keyword(s):

Stereotactic Radiosurgery ◽

Treatment Modality ◽

Surgical Excision ◽

Primary Treatment ◽

Benign Tumors ◽

Noninvasive Treatment ◽

Thoracic Spinal ◽

Primary Treatment Modality ◽

Microsurgical Resection ◽

Spinal Schwannoma

Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC) system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

Download Full-text

Radiation Therapy: A Primary Treatment Modality for Seminoma

Urologic Clinics of North America ◽

10.1016/s0094-0143(21)00166-x ◽

1980 ◽

Vol 7 (3) ◽

pp. 757-764

Author(s):

Ray E. Stutzman ◽

David G. McLeod

Keyword(s):

Radiation Therapy ◽

Treatment Modality ◽

Primary Treatment ◽

Primary Treatment Modality

Download Full-text

Endovascular embolization of high-grade cerebral dural arteriovenous fistulas - assessment of long-term recurrences

Interventional Neuroradiology ◽

10.1177/15910199211038277 ◽

2021 ◽

pp. 159101992110382

Author(s):

Alan Mendez-Ruiz ◽

Waldo R Guerrero ◽

Viktor Szeder ◽

Mudassir Farooqui ◽

Cynthia B Zevallos ◽

...

Keyword(s):

Endovascular Therapy ◽

Dural Arteriovenous Fistula ◽

High Flow ◽

High Grade ◽

Complete Occlusion ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Mean Time

Introduction Endovascular therapy has shown to be safe and effective for the treatment of cerebral dural arteriovenous fistulas; however, recurrence after complete occlusion is not uncommon, and the timing of recurrence remains unknown. Methods A retrospective single-center cohort study was conducted from January 2005 to December 2020. Patients with high-grade (≥Borden II–Cognard IIB) dural arteriovenous fistulas treated with endovascular therapy were included in this study. Clinical and angiographic characteristics were collected for hospitalization and at follow-up. Results A total of 51 patients with a median age of 61 years were studied; 57% were female. High-flow symptoms related to the high-flow fistula were the most common presentation (67%), and 24% presented with intracranial hemorrhage. Transverse-sigmoid (26%) and cavernous (26%) sinuses were the most common dural arteriovenous fistula locations. A total of 40 patients (70%) had middle meningeal arterial feeders and 4 (7%) had deep cerebral venous drainage. The mean number of embolization procedures per patient was 1.4. Transarterial access was the most frequent approach (61%). Onyx alone was the most common embolic agent (26%). Complete occlusion rate was achieved in 46 patients (80.1%). Last mean radiographic follow-up time was 26.7 months for all 57 dural arteriovenous fistulas. Dural arteriovenous fistula recurrence after radiographic resolution at last treatment was seen in six cases (6/46, 13.1%). Mean time for recurrence was 15.8 months. Mean time of last clinical follow-up was 46.1 months for the 51 patients (100%). A total of 10 (20%) experienced any procedural complications, among which two (4%) became major thromboembolic events. Conclusion Endovascular therapy is safe and effective for the treatment of high-grade dural arteriovenous fistulas. Given the significant recurrence rate of embolized dural arteriovenous fistulas even after 2 years, long-term angiographic follow-up might be needed.

Download Full-text

Glossopharyngeal Neuralgia

Pain Neurosurgery ◽

10.1093/med/9780190887674.003.0004 ◽

2019 ◽

pp. 23-30

Author(s):

Oren Sagher

Keyword(s):

Weight Loss ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Medical Management ◽

Treatment Modality ◽

Primary Treatment ◽

Glossopharyngeal Neuralgia ◽

Pain Condition ◽

Primary Treatment Modality ◽

Posterior Tongue

Glossopharyngeal neuralgia is an uncommon, but devastating pain condition. It shares many features with trigeminal neuralgia, but predominantly affects the posterior tongue and pharynx. Since glossopharyngeal neuralgia pain is frequently triggered by swallowing or movement of the tongue, patients frequently present with weight loss and dehydration. This chapter describes the classic features of this condition, including its association with syncope. The medical management of glossopharyngeal neuralgia is outlined as a primary treatment modality. Surgical considerations are also described, including microvascular decompression or sectioning of the glossopharyngeal nerve. Surgical pearls for both of these procedures are outlined, as well as strategies for complication avoidance and management.

Download Full-text

Transylvian Clip Occlusion of an Enlarging High-Flow Tentorial Arteriovenous Fistula: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz344 ◽

2019 ◽

Vol 19 (2) ◽

pp. E172-E173 ◽

Cited By ~ 1

Author(s):

Salomon Cohen-Cohen ◽

Michael J Link ◽

Leonardo Rangel-Castilla

Keyword(s):

Indocyanine Green Angiography ◽

Venous Drainage ◽

Transverse Sinus ◽

Primary Treatment ◽

High Flow ◽

Arteriovenous Fistulas ◽

Surgical Access ◽

Dural Arteriovenous Fistulas ◽

Clip Occlusion ◽

Neurologically Intact

Abstract Endovascular therapy is the primary treatment for the majority of tentorial dural arteriovenous fistulas (dAVF). Surgical occlusion is an effective alternative when embolization is not possible. This video demonstrates microsugical occlusion of a right-sided tentorial dAVF in a symptomatic 45-yr-old male. The dAVF was fed directly by meningohypophyseal trunk. Venous drainage was retrograde through the sphenoparietal sinus, superficial sylvian vein, vein of Labee, and transverse sinus. The patient underwent a right-sided pterional craniotomy; the sylvian fissure was widely opened. Subarachoid dissection was performed until a large arterialized draining vein was identified exiting dura subtemporally. Intraoperative indocyanine green angiography confirmed the fistulous site and the draining vein was occluded and divided. The patient remained neurologically intact after surgery. Immediate angiography demonstrates complete occlusion of the dAVF. This video demonstrates the surgical access obtained through a transylvian approach for this tentorial dAVF. Occlusion of the draining vein, with or without resection of the fistula, is enough to permanently treat these lesions.

Download Full-text