Unique percutaneous direct puncture technique for occlusion of a hypoglossal canal dural arteriovenous fistula

2018 ◽  
Vol 10 (12) ◽  
pp. 1179-1182 ◽  
Author(s):  
Orlando M Diaz ◽  
Maria M Toledo ◽  
John O F Roehm ◽  
Richard P Klucznik ◽  
Ponraj Chinnadurai ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Embolic Agent ◽  
Direct Puncture ◽  
Ethylene Vinyl Alcohol ◽  
Siemens Healthcare ◽  
Hypoglossal Canal ◽  
Liquid Embolic Agent ◽  
Detachable Coils ◽  
Anterior Condylar Vein

PurposeTo report percutaneous transcranial puncture, embolization and occlusion of a very symptomatic hypoglossal canal/anterior condylar vein dural arteriovenous fistula (DAVF) using syngo iGuide navigational software in a patient in whom transarterial and transvenous embolization and surgery had failed.MethodsAfter unsuccessful arterial and venous embolization and surgical treatment of a symptomatic hypoglossal canal DAVF, a 47-year-old man was transferred for further management. With exquisite anatomic detail provided by C-arm cone-beam computed tomography (CBCT) equipment (Artis zee Biplane, Dyna CT VC21H, Siemens Healthcare GmbH, Germany) and syngo iGuide needle guidance navigational software (Siemens Healthcare GmbHy) for planning a safe direct approach, the hypoglossal/anterior condylar vein, the dominant outflow vein of the fistula, was needle punctured percutaneously at the hypoglossal foramen and occluded with ethylene vinyl alcohol copolymer liquid embolic agent (Onyx, Medtronic, Minneapolis, Minnesota, USA) after placing two anchoring platinum coils (Target detachable coils, Stryker Neurovascular, Fremont, California, USA).ResultsAfter a year of progressively severe left eye proptosis, chemosis and increased intraocular pressure, the symptoms quickly subsided after this embolization and the patient was symptom free at his 3-month and later checkups.ConclusionWith guidance and imaging provided by CBCT and syngo iGuide navigational software, an otherwise untreatable DAVF was successfully embolized and obliterated by an aggressive unique percutaneous trans-cranial needle puncture of the dominant outflow vein in the hypoglossal canal.

Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (Onyx) arterial embolization as the primary modality: short-term results

2007 ◽  
Vol 107 (6) ◽  
pp. 1120-1125 ◽  
Author(s):  
Andrew P. Carlson ◽  
Christopher L. Taylor ◽  
Howard Yonas
Keyword(s):  
Arteriovenous Fistula ◽  
Vinyl Alcohol ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Arterial Embolization ◽  
Primary Treatment ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Treatment Agent

Object A dural arteriovenous fistula (DAVF) typically involves meningeal feeding arteries and can cause clinical symptoms ranging from tinnitus to rupture of draining cortical or parenchymal veins. Surgical treatment may be technically demanding. Ethylene vinyl alcohol (Onyx, ev3 Neurovascular) has several properties that make it potentially useful as a primary treatment agent for DAVF. Onyx is expected to be a permanent embolic agent. It should have a decreased risk of catheter retention when compared with other permanent embolic materials. Methods The authors report a series of six patients with symptomatic DAVF who were treated initially with transarterial Onyx embolization and other endovascular techniques. Results Five patients had complete occlusion of their DAVF noted on the follow-up angiogram obtained between 2 and 4 months. One patient had residual filling via a small arterial branch that was stable on follow-up angiography. None of the patients had worsening of neurological function. One case was complicated by a retained catheter fragment. Conclusions Transarterial Onyx embolization and other endovascular methods can angiographically obliterate DAVF. In some cases, embolization allowed occlusion of multiple arterial feeding arteries from a single arterial injection. Technically, the embolization was optimized when a microcatheter position immediately adjacent to the point(s) of fistulization was achieved.

scholarly journals Dural Arteriovenous Fistula at the Anterior Condylar Confluence

2008 ◽  
Vol 14 (3) ◽  
pp. 303-312 ◽  
Author(s):  
S. Miyachi ◽  
T. Ohshima ◽  
T. Izumi ◽  
T. Kojima ◽  
J Yoshida
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Three Dimensional ◽  
Drainage Pattern ◽  
Hypoglossal Canal ◽  
Shunt Occlusion ◽  
Meningeal Arteries ◽  
Anterior Condylar Vein ◽  
Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

Treatment of a Superior Sagittal Sinus Dural Arteriovenous Fistula with Onyx: Technical Case Report

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-E169-ONS-E170 ◽  
Author(s):  
Anil Arat ◽  
Servet Inci
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Definitive Treatment ◽  
Embolic Agent ◽  
External Carotid ◽  
Cerebral Angiogram ◽  
Ethylene Vinyl Alcohol ◽  
Sagittal Sinus

Abstract OBJECTIVE: The endovascular treatment of a complex superior sagittal sinus dural arteriovenous fistula with ethylene vinyl alcohol copolymer (Onyx) in one session is described. CLINICAL PRESENTATION: A 54-year-old man presented with dizziness and a bruit. A cerebral angiogram demonstrated a superior sagittal sinus dural arteriovenous fistula with a patent superior sagittal sinus that was supplied via multiple branches of the external carotid arteries bilaterally and the left anterior and middle cerebral arteries. Drainage was mainly through the superior sagittal sinus and, only in part, retrogradely through the cortical veins. A decision was made to proceed with endovascular treatment followed by surgery. INTERVENTION: Transarterial injection of one pedicle of middle meningeal artery on both sides with Onyx resulted in complete obliteration of the dural supply and some of the pial supply to the malformation without complications. The superior sagittal sinus remained patent. Based on this result, surgical treatment was cancelled. The residual pial supply had disappeared by the 10-month angiographic follow-up examination and the patient remained neurologically intact and without symptoms. CONCLUSION: Definitive treatment may be attained with Onyx in dural arteriovenous fistulas. The potential of Onyx for use as a permanent embolic agent in dural arteriovenous fistulae needs to be investigated.

scholarly journals Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure

2009 ◽  
Vol 15 (2) ◽  
pp. 179-184 ◽  
Author(s):  
N. Amiridze ◽  
G. Zoarski ◽  
R. Darwish ◽  
A. Obuchowski ◽  
N. Soloveychic
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Interventional Therapy ◽  
Superior Orbital Fissure ◽  
Direct Puncture ◽  
Ethylene Vinyl Alcohol ◽  
Trigeminocardiac Reflex ◽  
Ocular Symptoms ◽  
Transvenous Approach

Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging. We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy. Successful occlusion of the fistula was subsequently achieved with injection of ethylene vinyl alcohol copolymer, Onyx (EV3 Neurovascular, Irvine, CA, USA), via direct percutaneous puncture of the cavernous sinus through the superior orbital fissure. A brief period of asystole during the initial injection of Onyx may be the result of the trigeminocardiac reflex.

Direct Puncture of the Cavernous Sinus as Alternative Approach to Treat a Dural Arteriovenous Fistula of the Hypoglossal Canal

2019 ◽  
Vol 30 (1) ◽  
pp. 185-188
Author(s):  
Johnni Zamponi Júnior ◽  
Felipe Padovani Trivelato ◽  
Alexandre Cordeiro Ulhôa ◽  
Marco Túlio Rezende
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Direct Puncture ◽  
Hypoglossal Canal ◽  
Alternative Approach

scholarly journals Endovascular Treatment of Intracranial Pial–Dural Arteriovenous Fistula: A Case Report

2020 ◽  
Vol 06 (02) ◽  
pp. e118-e124
Author(s):  
D. V. Shchehlov ◽  
S. V. Konotopchyk ◽  
O. E. Svyrydiuk ◽  
I. M. Bortnik ◽  
M.Y. Momonova ◽  
...  
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
High Flow ◽  
Embolic Agent ◽  
Venous Stasis ◽  
Dural Sinus ◽  
Liquid Embolic ◽  
Liquid Embolic Agent

AbstractIntracranial pial arteriovenous fistula (PAVF) is a rare cerebrovascular pathology characterized by abnormal direct high-flow connection between the pial or cortical feeding artery and draining vein. Dural arteriovenous fistula (DAVF) is a pathological shunt between the meningeal arteries and dural sinuses or meningeal veins. In case of association between PAVF and DAVF, diagnosis and treatment are more challenging. The high-flow arteriovenous shunt and deep venous drainage make PAVF more preferable for endovascular treatment; however, their embolization during single-session procedures can lead to extensive thrombosis of the draining veins and unfavorable outcomes. We present a case report of endovascular embolization of an intracranial PAVF–DAVF in a 2.5-year-old child. At the time of admission, the patient had hydrocephalus, mental retardation, pyramidal insufficiency, and seizures. Occlusion of the fistula was performed during two stages of embolization to reduce the risk of severe venous stasis and venous thrombosis. Guglielmi detachable coils (GDCs) and a liquid embolic agent (Histoacryl with Lipiodol) were used for embolization. The patient recovered well after the procedure, with significant mental improvement. This suggests that the deployment of GDCs in the afferent artery near a fistula before embolization with a liquid embolic agent can minimize the risk of uncontrolled penetration of the embolization into the draining veins and dural sinus. A multisession procedure can be an effective and reasonable method of PAVF and DAVF occlusion among existing treatment options.

scholarly journals Transvenous Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Embolization with Platinum Coils and Onyx HD 500+

2005 ◽  
Vol 11 (3) ◽  
pp. 281-286 ◽  
Author(s):  
R. Siekmann ◽  
W. Weber ◽  
B. Kis ◽  
D. Kühne
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Balloon Occlusion ◽  
Embolic Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Transvenous Approach ◽  
Platinum Coils

We report the endovascular treatment of a symptomatic dural arteriovenous fistula in a 61-year-old male patient. The medial portion of the fistula was occluded with detachable platinum coils during an initial intervention using a transvenous approach. Due to persistence of the symptoms in a second intervention eight months later the fistula was completely occluded by the transvenous introduction of a liquid embolic agent (Onyx 500+). The liquid embolic agent was introduced under protection by the temporary balloon occlusion of the fistula's venous drainage. After the procedure, the patient was treated for three months with 75 mg clopidogrel (Plavix®) and with 100 mg acetylsalicylic acid (ASS®). A few days after the intervention, the patient was discharged without any neurological deficit and in good clinical condition. The follow-up examination six months later neither detected a recurrence of the dural arteriovenous fistula in the angiogram nor any neurological symptoms.

Eight-year follow-up after palliative embolization of a neonatal intracranial dural arteriovenous fistula with high-output heart failure: management strategies for symptomatic fistula growth and bilateral femoral occlusions in pediatric patients

2010 ◽  
Vol 6 (6) ◽  
pp. 553-558 ◽  
Author(s):  
Adam S. Reig ◽  
Scott D. Simon ◽  
Wallace W. Neblett ◽  
Robert A. Mericle
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Cardiac Failure ◽  
Dural Arteriovenous Fistula ◽  
Management Strategies ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
High Output

The authors report the 8-year follow-up of a patient previously described in the literature who originally presented in high-output cardiac failure secondary to a complex neonatal intracranial dural arteriovenous fistula (DAVF). The earlier case report described palliative treatment with a combination of extracorporeal membrane oxygenation (ECMO) and endovascular embolization for life-threatening high-output cardiac failure secondary to a DAVF. Access was obtained using the ECMO cannula, and embolization was performed while the patient was connected to the ECMO machine. The patient made an excellent recovery following partial embolization of the fistula, but then presented again 7 years later with worsening headaches secondary to significant growth of the known residual portion of the fistula identified on CT angiography. The child also developed bilateral femoral artery (FA) occlusions secondary to multiple previous FA punctures. To achieve complete obliteration of the remaining fistula, the patient required a retroperitoneal approach to the iliac artery and percutaneous puncture of the internal jugular vein. Embolization was performed with a combination of platinum coils and ethylene vinyl alcohol copolymer liquid embolic agent. There were no complications, and the child remains neurologically normal, with no signs of permanent cardiovascular sequelae. In this case report, the authors discuss the long-term management of AVFs treated by endovascular strategies early in life. After neonatal access, sometimes the FAs occlude, requiring more invasive access strategies. The authors also discuss the follow-up method, intervals, and threshold for further treatment for these lesions, and present a review of the literature.

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