Abstract 1122‐000160: Transvenous Embolization Technique: A Modern Strategy for Anterior Ethmoidal Dural Arteriovenous Fistulas

Introduction : Ethmoidal dural arteriovenous fistulae (AVF) are rare intracranial lesions and account for 2–3% of all dAVF. They are often supplied by the ethmoidal or falcine branches of the ophthalmic artery and typically drain into a cortical vein then into the superior sagittal sinus (SSS). Current available treatment options include surgical resection and endovascular embolization via transarterial and transvenous routes. Prior studies have solely compared surgical and transarterial endovascular treatment approaches. Reports of the transvenous approach remain scarce in the literature. Methods : We performed a retrospective review for anterior ethmoidal (AE)‐dAVFs treated with transvenous embolization by our practice between August 2018 and August 2021. Four patients with 5 dAVFs were identified. We describe the presentation, treatment, and outcome of these cases. Results : We describe four patients with AE‐dAVF. Case 1 is a 33‐year‐old man with a previously treated basal ganglia arteriovenous malformation achieving cure. He was lost for follow up for three years and returned with symptoms of peri‐orbital headache and blurry vision. Diagnostic angiography revealed a dAVF arising from the cribriform plate with arterial supply derived from bilateral AE arteries and venous drainage via a common cortical frontal interhemispheric vein to the anterior third of the SSS. Transvenous embolization was achieved and liquid embolic was injected into the vein with retrograde penetration to the fistulous point. Follow‐up angiography revealed obliteration of the dAVF. Case 2 is a 23‐year‐old man with chronic headache who was found to have a right sided ethmoidal dAVF arising from the right ophthalmic artery for which he underwent successful embolization through a transarterial approach. Follow‐up angiography demonstrated occlusion of the treated fistula and new left sided ethmoidal AVF arising from the left ophthalmic artery with a single draining cerebral vein which drains into the anterior third of the SSS. Transvenous embolization was achieved via coiling. Follow up angiography also showed complete occlusion of the dAVF. Case 3 was a 67‐year‐old woman who presented with a Cognard type III right ethmoidal dAVF with arterial feeders through surpra‐orbital branches of the right ophthalmic artery, draining into a frontal cortical vein leading to the SSS. The patient underwent transvenous embolization using coils. Case 4 was a 64‐year‐old woman who presented with scalp tenderness. Diagnostic angiography revealed a left AE‐dAVF. Transvenous embolization with complete occlusion was achieved using a combination of liquid embolic and coil embolization. No adverse events were encountered during or after embolization, but long‐term outcome has yet to be collected for cases 3 and 4. There were no neurologic procedural complications. Conclusions : This small case series shows that transvenous embolization is a feasible, effective, and safe alternative to surgery. Larger prospective studies are needed to further validate this treatment approach in patients with ethmoidal dAVF.