scholarly journals Endovascular coil embolization of a spinal epidural arteriovenous fistula with associated cord compression from an enlarging venous varix

2015 ◽  
Vol 21 (6) ◽  
pp. 738-741 ◽  
Author(s):  
Dale Ding ◽  
Robert M Starke ◽  
David Manka ◽  
R Webster Crowley ◽  
Kenneth C Liu
Keyword(s):  
Coil Embolization ◽  
Venous Drainage ◽  
Cord Compression ◽  
Technical Note ◽  
Arteriovenous Fistulas ◽  
Endovascular Coil Embolization ◽  
The Right ◽  
Spinal Epidural ◽  
Venous Varix

Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20 × 13 mm2 contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26 × 16 mm2. The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF.

scholarly journals Onyx embolization of a pial AV fistula with a giant venous varix using a flow-directed Scepter balloon catheter: Technical note

2018 ◽  
Vol 24 (6) ◽  
pp. 702-705
Author(s):  
Andrew S Griffin ◽  
Nicholas Befera ◽  
Erik Hauck
Keyword(s):  
High Risk ◽  
Balloon Catheter ◽  
Brain Magnetic Resonance Imaging ◽  
Technical Note ◽  
Cerebral Angiogram ◽  
Av Fistula ◽  
Arteriovenous Fistulas ◽  
The Right ◽  
Risk Of Hemorrhage ◽  
Venous Varix

Background and importance Pial arteriovenous fistulas (AVFs) of the brain are treacherous lesions that can be challenging to treat because of high risk of hemorrhage. We report on a rare case of a pial AVF with a giant venous varix as a draining vein treated successfully with flow-directed balloon-assisted Onyx embolization. Clinical presentation A 56-year-old female with headaches underwent brain magnetic resonance imaging, which demonstrated a 4 cm aneurysmal malformation in the right temporal lobe. A diagnostic cerebral angiogram demonstrated a right temporal pial AVF fed by an enlarged right posterior cerebral artery with drainage into a giant venous varix. Onyx embolization was curative using a flow-directed Scepter balloon catheter. Conclusion Flow-directed balloon-assisted Onyx embolization can be highly successful for the curative embolization of pial AVFs. Balloon application changes the nature of the lesion from high-flow–high risk to no-flow–low-risk. Using a flow-directed technique with balloon microcatheters may help minimize the risk of intracranial vascular injury.

“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Kristine Ravina ◽  
Aristotelis Filippidis ◽  
Christopher S Ogilvy
Keyword(s):  
Surgical Resection ◽  
Endovascular Embolization ◽  
Acute Onset ◽  
Bone Flap ◽  
Intracranial Arteriovenous Malformation ◽  
Excessive Bleeding ◽  
Left Hand ◽  
The Right ◽  
Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

scholarly journals Spontaneous Thrombosis of a Middle Meningeal Arteriovenous Fistula With Subsequent Pseudoaneurysm Formation: Case Report and Review of Literature

2020 ◽  
Vol 1 (3) ◽  
Author(s):  
Pouya Nazari ◽  
Pedram Golnari ◽  
Madhav Sukumaran ◽  
Ali Shaibani ◽  
Michael C Hurley ◽  
...  
Keyword(s):  
Unusual Case ◽  
Middle Meningeal Artery ◽  
Complete Healing ◽  
Spontaneous Thrombosis ◽  
Pseudoaneurysm Formation ◽  
Arteriovenous Fistulas ◽  
History Of ◽  
The Right ◽  
Repeat Imaging

ABSTRACT BACKGROUND AND IMPORTANCE Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results. CLINICAL PRESENTATION A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm. CONCLUSION Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.

Spinal epidural arteriovenous fistulas associated with progressive myelopathy

2007 ◽  
Vol 6 (6) ◽  
pp. 552-558 ◽  
Author(s):  
Nivaldo Silva ◽  
Anne Christine Januel ◽  
Philippe Tall ◽  
Christophe Cognard
Keyword(s):  
Magnetic Resonance Imaging ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Arterial Access ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Spinal Epidural

✓The authors report the cases of four patients who presented with progressive myelopathy (one patient had been asymptomatic for 25 years) due to spinal epidural arteriovenous fistulas (AVFs). Clinical symptoms and magnetic resonance imaging findings were similar to those of dural AVFs. In contrast to dural AVFs, angiography showed that the lesions were fed by multiple vessels and drained in one case in multiple veins. Perimedullary venous drainage was visible in three of the four cases. All fistulas were cured by embolization; arterial access was used in two cases and venous in two. The authors' aim in this paper is to emphasize the differences between dural and epidural AVFs in terms of their physiopathology and angioarchitecture as well as the therapeutic strategy.

scholarly journals Spinal epidural arteriovenous fistula embolization with ethylene vinyl alcohol (EVOH) copolymer using the Scepter Mini dual-lumen balloon

2020 ◽  
pp. neurintsurg-2020-016395
Author(s):  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Arnaud Pouvelle ◽  
Kevin Premat ◽  
Stéphanie Lenck ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Cord Compression ◽  
Embolic Agent ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Arteriovenous Fistulas ◽  
Low Profile ◽  
Liquid Embolic Agent ◽  
Av Fistulas ◽  
Spinal Epidural

Left unattended, spinal epidural arteriovenous fistulas (EAVFs) have a potentially severe clinical course. Embolization using ethylene vinyl alcohol (EVOH) copolymers through regular dual-lumen balloons has emerged as a potential option for the treatment of spinal arteriovenous (AV) fistulas;1–3 the main issue with this technique is the navigability of these balloons. The Scepter Mini is a low-profile, dual-lumen balloon, which may be helpful for EVOH embolization of spinal AV fistulas, as it may help to overcome the navigation drawbacks. In this technical video, we present a case of EVOH embolization of a right T6 spinal EAVF through a Scepter Mini balloon. Of note, particular attention should be paid to radiculomedullary arteries arising at the same level or at adjacent levels to avoid severe neurologic complications related to uncontrolled migration of the liquid embolic agent. Moreover, excessive use of embolic material should be avoided to prevent spinal cord compression (video 1).Video 1

scholarly journals Relationship between Focal Inflammation and Symptom Exacerbation after Endovascular Coil Embolization for Symptomatic Intracranial Aneurysms

2008 ◽  
Vol 14 (2) ◽  
pp. 179-184
Author(s):  
S. Suzuki ◽  
A. Kurata ◽  
K. Iwamoto ◽  
M. Yamada ◽  
J. Niki ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cranial Nerve ◽  
Anticoagulation Therapy ◽  
Unruptured Aneurysms ◽  
Anti Platelet Therapy ◽  
Symptom Exacerbation ◽  
Endovascular Coil Embolization ◽  
Inflammatory Drugs ◽  
Continuous Injection

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial. We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation. The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received anti-platelet therapy. At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms. In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently. Our findings suggest that post-EVS follow-up is necessary and that patients exhibiting an inflammatory reaction be treated with anti-inflammatory drugs.

scholarly journals Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

2013 ◽  
Vol 34 (5) ◽  
pp. E15 ◽  
Author(s):  
David J. Daniels ◽  
Ananth K. Vellimana ◽  
Gregory J. Zipfel ◽  
Giuseppe Lanzino
Keyword(s):  
Clinical Features ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Residual Symptoms ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

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