scholarly journals Dural Arteriovenous Fistulas: Unusual Access Routes in the Elderly

2005 ◽  
Vol 11 (4) ◽  
pp. 377-381 ◽  
Author(s):  
G. Andrade ◽  
R. Marques ◽  
N. Brito Pires ◽  
C. Abath
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Sinus Thrombosis ◽  
The Elderly ◽  
Venous Access ◽  
Transvenous Embolization ◽  
Superior Ophthalmic Vein ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Detachable Coils

Transvenous embolization is effective in the treatment of an intracranial dural arteriovenous fistula (DAVF). Retrograde venous access to the fistula may be limited by associated sinus thrombosis, as in the two cases here reported. Unusual curative access routes were performed: direct superior ophthalmic vein puncture and through a small craniectomy, packing the sinus with detachable coils. When traditional routes proved impossible, unusual access routes must be devised.

scholarly journals Microsurgical treatment of a posterior fossa arteriovenous malformation initially mistaken for a dural arteriovenous fistula: avoidance of near disaster

2021 ◽  
Vol 4 (1) ◽  
pp. V7
Author(s):  
Brian M. Howard ◽  
Daniel L. Barrow
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Fatal Hemorrhage ◽  
Hemorrhagic Complications ◽  
Dural Arteriovenous Fistulas

Many brain arteriovenous malformations (AVMs) derive dural blood supply, while 10%–15% of dural arteriovenous fistulas (dAVFs) have pial arterial input. To differentiate between the two is critical, as treatment of these entities is diametrically opposed. To treat dAVFs, the draining vein(s) is disconnected from feeding arteries, which portends hemorrhagic complications for AVMs. The authors present an operative video of a subtle cerebellar AVM initially treated as a dAVF by attempted embolization through dural vessels. The lesion was subsequently microsurgically extirpated. The authors show a comparison case of an AVM mistaken for a dAVF and transvenous embolization that resulted in a fatal hemorrhage.The video can be found here: https://youtu.be/eDeiMrGoE0Q

Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas

2021 ◽  
pp. 197140092110428
Author(s):  
Madhavi Duvvuri ◽  
Michael T Caton ◽  
Kazim Narsinh ◽  
Matthew R Amans
Keyword(s):  
Arteriovenous Fistula ◽  
Coil Embolization ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Sigmoid Sinus ◽  
Transvenous Embolization ◽  
Venous Infarction ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Superior Petrosal Sinus

Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.

Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula

2006 ◽  
Vol 104 (6) ◽  
pp. 974-977 ◽  
Author(s):  
Mami Hanaoka ◽  
Koichi Satoh ◽  
Junichiro Satomi ◽  
Shunji Matsubara ◽  
Shinji Nagahiro ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Novel Technique ◽  
Dural Arteriovenous Fistulas ◽  
Gooseneck Snare

✓ The authors describe a novel technique involving the use of a gooseneck snare for microcatheterization of isolated sinus dural arteriovenous fistulas (DAVFs). In some patients the inferior petrosal and transverse–sigmoid sinuses, the route of transvenous embolization (TVE) for DAVF, are separated by several channels. Even if a guidewire can be passed over the occluded portion and the affected sinus can be accessed, one may not necessarily be able to insert a microcatheter. The authors report on three patients who underwent successful microcatheterization via a novel pull-up technique, which makes use of a gooseneck snare to perform TVE even in very difficult circumstances.

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

2021 ◽  
pp. 1-10
Author(s):  
Isaac Josh Abecassis ◽  
R. Michael Meyer ◽  
Michael R. Levitt ◽  
Jason P. Sheehan ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Fistula ◽  
Outcomes Research ◽  
Intracranial Aneurysms ◽  
Dural Arteriovenous Fistula ◽  
Aneurysm Rupture ◽  
External Carotid ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

scholarly journals Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Md Moshiur Rahman
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
External Jugular Vein ◽  
Middle Income ◽  
Arteriovenous Fistulas ◽  
Middle Income Countries ◽  
Dural Arteriovenous Fistulas ◽  
Superior Longitudinal Sinus ◽  
Transvenous Approach

Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.

scholarly journals Transvenous Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 85-92 ◽  
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
N. Tomura ◽  
J. Watarai ◽  
K. Mizoi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Gadopentetate Dimeglumine ◽  
Venous Access ◽  
Transvenous Embolization ◽  
Mr Images ◽  
Transfemoral Approach ◽  
Posterior Portion ◽  
Contrast Enhanced

We reviewed magnetic resonance (MR) images and digital subtraction angiograms (DSA) from eight patients with dural arteriovenous fistula of the cavernous sinus (DAVFCS) to clarify the fistulous points and to evaluate the venous access routes into the cavernous sinus for transvenous embolization (TVE). Multiplanar reconstruction of the MR images was achieved using three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) after the intravenous administration of gadopentetate dimeglumine (Gd-DTPA). TVE was performed using microcoils via the inferior petrosal sinus (IPS) using the transfemoral approach in five patients, via the facial vein and superior ophthalmic vein (SOV) using the transfemoral approach in 1 patient, and by SOV puncture in two patients. Most fistulas were detected in the posterior portion of the cavernous sinus or in the posterior intercavernous sinus in all of the patients. Fistulas identified as hyperintense dots or lines on contrast-enhanced 3-D fast SPGR images and were replaced with the microcoils. Target embolization of the fistulas was feasible in three patients treated via the SOV and in one patient treated via the IPS. Contrast-enhanced 3-D fast SPGR can help to identify the fistulous points of DAVFCS. Precise identification of fistulous points and selection of the adequate access route are mandatory for efficient TVE of DAVFCS.

scholarly journals Delayed Onset of Dural Arteriovenous Fistula Following Trauma

Reports ◽  
2019 ◽  
Vol 2 (2) ◽  
pp. 14
Author(s):  
William Richardson ◽  
Praveen Satarasinghe ◽  
Michael T. Koltz
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Delayed Diagnosis ◽  
Type Ii ◽  
Unique Case ◽  
Arteriovenous Fistulas ◽  
Delayed Onset ◽  
Dural Arteriovenous Fistulas ◽  
Medical Histories ◽  
Hospital Days

Dural Arteriovenous Fistulas (dAVF) are pathological shunts that are often idiopathic in presentation. However, it is reported that many patients presenting with dAVF have past medical histories notable for surgeries, hypercoagulation disorders, infections, and trauma. In trauma-linked dAVF, presentation generally occurs within 48 h post-incident. In the present case, the authors discuss the delayed onset of a Borden type II dAVF in a patient 12 hospital days post-trauma, as well as the course of treatment. This unique case provides a compelling demonstration for providers to be aware of the development of dAVF, even after the typical 48-hour post-trauma window. By being aware of the possibility of delayed dAVF presentation, delayed diagnosis or misdiagnosis can be avoided and emergent action can be taken.

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