scholarly journals Transvenous Treatment of Cranial Dural Arteriovenous Fistulas with Hydrogel Coated Coils

2006 ◽  
Vol 12 (4) ◽  
pp. 319-326 ◽  
Author(s):  
P. Klurfan ◽  
T. Gunnarsson ◽  
I. Shelef ◽  
K.G. Terbrugge ◽  
R.A. Willinsky
Keyword(s):  
Venous Drainage ◽  
Venous Congestion ◽  
Embolic Agent ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Platinum Coil ◽  
Cortical Venous Reflux ◽  
Bare Platinum Coils ◽  
Transvenous Approach ◽  
Platinum Coils

Intracranial dural arteriovenous fistulas (DAVF) with cortical venous reflux may become symptomatic due to venous congestion or intracranial hemorrhage. Venous congestion in the orbit can also occur resulting in proptosis, chemosis, double vision and progressive visual loss. The transvenous approach has been used for selective disconnection of the venous drainage to eliminate the venous congestion and future risk of intracranial bleeding and/or neurological deficit. Hydrogel coated coils (HydroCoil®) expand after contact with blood causing the coils to swell up to five to 11 times a standard 10-system bare platinum coil. Due to this property, HydroCoils could have an advantage over platinum coils in the transvenous approach to embolization of DAVFs. Ten patients with symptomatic cranial DAVF underwent a transvenous embolization using HydroCoils as the only embolic agent or in a combination with bare platinum coils. The patients' characteristics, symptoms, angioarchitecture of the DAVF, treatment, complications and results were analyzed. All the treated DAVFs were disconnected at the end of the procedure. All the patients with orbital symptoms had complete or significant improvement. There were no periprocedural complications. Nine patients had radiological follow-up showing cure. HydroCoils can be used effectively and safely to treat intracranial DAVFs transvenously. The volume expansion of Hydrocoils may have significant advantage over bare platinum coils given the large venous spaces that need to be filled. The use of HydroCoils may decrease the procedure time and consequently reduce the radiation dose to the patient.

scholarly journals Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

2020 ◽  
Vol 10 (2) ◽  
pp. 84-93
Author(s):  
Volker Maus ◽  
Finn Drescher ◽  
Lukas Goertz ◽  
Anushe Weber ◽  
Werner Weber ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Success ◽  
Embolic Agent ◽  
Common Symptom ◽  
Arteriovenous Fistulas ◽  
Patient Demographics ◽  
Single Center Experience ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Reflux

Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.

scholarly journals Transvenous Occlusion of a Dural Cavernous Sinus Fistula Using a New Expandable Hydrogel-Platinum Coil (Hydrocoil®)

2004 ◽  
Vol 10 (2) ◽  
pp. 151-154 ◽  
Author(s):  
H. Morsi ◽  
G. Benndorf ◽  
R. Klucznik ◽  
M. Mawad
Keyword(s):  
Cavernous Sinus ◽  
Clinical Investigation ◽  
Cerebral Aneurysms ◽  
Parent Vessel ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Complex Aneurysms ◽  
Platinum Coil ◽  
Bare Platinum Coils ◽  
Platinum Coils

Hydrogel-coated platinum coils (Hydrocoils®) are currently under clinical investigation for their efficacy to improve anatomic results of endovascular occlusion of cerebral aneurysms. A case is presented in which this new expandable coil type was added to bare platinum coils in order to accelerate the transvenous occlusion of a dural cavernous sinus fistula (DCSF). A 53-year -old woman presenting with mild left-sided eye redness and diplopia due to a DCSF (type D) underwent transvenous occlusion using bare platinum coils (Trufill®) and hydrogel coated coils (Hydrocoil®). After successful catherization of the cavernous sinus, bare platinum coils were densely packed and eventually combined with Hydrocoils® which resulted in immediate and complete occlusion of the fistula. No technical or clinical complication occurred. The new expansile hydrogel-coated platinum coil (Hydrocoil®) can be successfully combined with bare platinum coils to accelerate transvenous occlusion of an AV-shunting lesion. Controlled volume expansion after deployment of this device offers potential benefits for occlusion of dural arteriovenous fistulas in other locations or for parent vessel occlusions in the treatment of giant or large complex aneurysms.

scholarly journals Transvenous Approach to Intracranial Dural Arteriovenous Fistula (Cognard V): A Treatment Option

2011 ◽  
Vol 17 (1) ◽  
pp. 108-114 ◽  
Author(s):  
S. Aixut Lorenzo ◽  
A. Tomasello Weitz ◽  
J. Blasco Andaluz ◽  
L. Sanroman Manzanera ◽  
J.M. Macho Fernández
Keyword(s):  
Endovascular Treatment ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Complete Disappearance ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Collateral Arteries ◽  
Dural Arteriovenous Fistulas ◽  
Type V ◽  
Transvenous Approach

The endovascular technique is the gold standard treatment in dural arteriovenous fistulas. Due to the limited number of series published it is difficult to create rigid guidelines in terms of the best endovascular treatment approach. Treatment must be tailored to each particular case, but it is important to keep in mind that the possibility of treating a type V dAVF by the transvenous approach should not be discarded. In selected cases the transvenous approach may be helpful to increase the chance of success in the endovascular treatment of type V dAVF. We describe a patient in whom the first arterial treatment failed to achieve occlusion of the fistulous point with the glue. Clinical symptoms improved due to the diminished flow at the fistula after the first embolization but as soon as collateral arteries were recruited by the fistula, spinal cord venous drainage impairment led to symptoms recurrence. Transvenous access allowed us to close the fistula completely in one only session with a complete disappearance of the pathologically inverted perimedullary venous flow.

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.

scholarly journals Critical Review of Clinical Aspects and Treatment Strategies of Cranial Dural Arteriovenous Malformations

2018 ◽  
Vol 22 (3) ◽  
pp. 87-94
Author(s):  
Marco Antônio Stefani ◽  
Apio Claudio Martins Antunes
Keyword(s):  
Treatment Strategies ◽  
Venous Drainage ◽  
Clinical Aspects ◽  
Venous Reflux ◽  
Venous Anatomy ◽  
Anatomical Features ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Cortical Venous Reflux

The authors discuss the treatment strategies for dural arteriovenous fistulas, considering  anatomical features such as the presence of cortical venous reflux (CVR) and patterns of  cerebral venous drainage. Illustrative cases are presented with the different clinical and angiographic features, focusing on patterns of arterial and venous anatomy, normal cerebral venous drainage and the presence of cortical venous reflux. A review of the pathophysiology and current classifications are presented. The treatment strategies are discussed, focusing on the endovascular procedures available. Dural arteriovenous fistulas should be treated considering the significant risks of hemorrhage related to the presence of CVR. Treatment strategies should aim angiographic and clinical cure, achieved with low risk of complications when using a multidisciplinar approach, after carefull understanding of the venous drainage, respecting the anatomy of the lesion and the normal cerebral venous drainage. 

scholarly journals Endovascular management of complex superior sagittal sinus dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V11
Author(s):  
André Beer-Furlan ◽  
Krishna C. Joshi ◽  
Hormuzdiyar H. Dasenbrock ◽  
Michael Chen
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Transvenous Approach

Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are rare and present unique challenges to treatment. Complex, often bilateral, arterial supply and involvement of large volumes of eloquent cortical venous drainage may necessitate multimodality therapy such as endovascular, microsurgical, and stereotactic radiosurgery techniques. The authors present a complex SSS DAVF associated with an occluded/severely stenotic SSS. The patient underwent a successful endovascular transvenous approach with complete obliteration of the SSS. The authors discuss the management challenges faced on this case.The video can be found here: https://youtu.be/-rztg0_cBXY.

Transvenous Approach to Intracranial Arteriovenous Malformations

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 644-652 ◽  
Author(s):  
Omar Choudhri ◽  
Michael E. Ivan ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Intracranial Arteriovenous Malformations ◽  
Arteriovenous Fistulas ◽  
Treatment Models ◽  
Dural Arteriovenous Fistulas ◽  
Transvenous Approach ◽  
The Brain

Abstract A compartmental conceptualization of intracranial arteriovenous malformations (AVMs) allows recognition of feeding arteries, an intervening plexiform nidus, and draining veins. AVM therapy involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and venous drainage of the brain. Traditional methods of AVM therapy through microsurgery and endovascular embolization involve arterial devascularization, with preservation of AVM venous drainage, until the nidus is excluded. The transvenous approach in treating vascular malformations was popularized by successful treatment models for dural arteriovenous fistulas. More recently, high-flow intracranial AVMs are being managed with transvenous endovascular approaches, although this novel technique has its challenges and perils. We review the current literature on transvenous AVM therapy and highlight its role for AVM therapy in the present day.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

scholarly journals Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 127-134 ◽  
Author(s):  
T. Kawaguchi ◽  
M. Nakatani ◽  
T. Kawano
Keyword(s):  
Emergency Treatment ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Sigmoid Sinus ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

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