scholarly journals Onyx versus nBCA and coils in the treatment of intracranial dural arteriovenous fistulas

2016 ◽  
Vol 22 (2) ◽  
pp. 212-216 ◽  
Author(s):  
Douglas M Choo ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Coil Embolization ◽  
Case Control Study ◽  
Venous Drainage ◽  
Case Control ◽  
Endovascular Embolization ◽  
Mortality And Morbidity ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage ◽  
Control Study

Background and purpose Intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage have significant morbidity and mortality. Complete closure of these lesions is necessary to reduce these risks. The purpose of our study was to compare the outcome of DAVFs treated with Onyx versus those treated with n-Butyl Cyanoacrylate (nBCA) and coil embolization in a case-control study. Compared with nBCA and coil embolization, we hypothesized that Onyx embolization for DAVF is safer and has a higher chance of complete obliteration, with no need for post-embolization surgery for the DAVF. Materials and methods From 1998 to 2015, 29 patients who had DAVFs were treated with endovascular embolization. Of these, 24 patients had imaging available for analysis. Successful closure rates, complications, and procedure time were compared between the embolization techniques. Results The chance of not requiring post-embolization surgery with Onyx (81.8%) was significantly higher ( p = 0.005) than with nBCA (22.22%). The complication rate with Onyx (9.1%) tended to be lower compared with that of nBCA (22.22%; p = 0.37). Procedural time was not significantly different between Onyx (mean 267 minutes) and nBCA (mean 288 minutes) ( p = 0.59). The odds ratio of a DAVF being treated with Onyx and then requiring no follow-up surgery was 17.5 (95% CI 1.97–155.4). Conclusion Our case-control study suggests that Onyx embolization is superior to nBCA and coil embolization in completely obliterating DAVFs, with higher odds of no post-embolization surgery. We also found that Onyx is safe for embolization of DAVFs, with no associated neurological mortality and morbidity.

scholarly journals Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

2015 ◽  
Vol 21 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Yongxin Zhang ◽  
Qiang Li ◽  
Qing-hai Huang
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Therapeutic Option ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Balloon Protection

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

scholarly journals Common determinants of Ca breast - a case control study in Lahore

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Shahid Mahmood ◽  
Tasneem Fatima Rana ◽  
Maaz Ahmad
Keyword(s):  
Case Control Study ◽  
Public Awareness ◽  
Case Control ◽  
Environmental Hazards ◽  
Young Age ◽  
Hormonal Contraceptives ◽  
Cancer Awareness ◽  
Mortality And Morbidity ◽  
And Control ◽  
Control Study

Background Ca breast is commonest malignancy in females all over the world and 2nd leading cause of death in females. In Pakistan, it is more common in young age (incidence in 30-39 years) contrary to west (over 65years). Genetics ,use of oral hormonal contraceptives, prolonged hormonal replacement therapy, environmental hazards and parity are also considered to play an important role in causation of ca. breast .This morbidity pattern of young age in Pakistan is a real concern for the health care planners and providers. Objectives:-To know the etiological factors in the area, to formulate a public awareness programme for reduction in mortality and morbidity due to breast cancer in Pakistan Study design:-Case Control Study. Place and duration of the study: - Mayo and INMOL hospitals. Jan-June, 2005.Respondants and methods:-Pre- tested questionnaire was used to interview the cases and control groups Results:-Ca breast is significantly more in married, young age, with 3 or more children, breast feeding moth ers. Conclusion: - Early marriages environmental hazards, genetic predisposition and hormonal imbalance are the most important suspected causes. Cancer awareness and screening programme with community participation are the best feasible approaches for rectification of the situation.

scholarly journals Arterial spin labeling MR imaging aids to identify cortical venous drainage of dural arteriovenous fistulas

Medicine ◽  
2018 ◽  
Vol 97 (19) ◽  
pp. e0697 ◽  
Author(s):  
Ji Hee Kang ◽  
Tae Jin Yun ◽  
Jong Kook Rhim ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Venous Drainage ◽  
Spin Labeling ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

scholarly journals Reconsidering an important subclass of high-risk dural arteriovenous fistulas for stereotactic radiosurgery

2019 ◽  
Vol 130 (3) ◽  
pp. 972-976 ◽  
Author(s):  
Daniel A. Tonetti ◽  
Bradley A. Gross ◽  
Brian T. Jankowitz ◽  
Hideyuki Kano ◽  
Edward A. Monaco ◽  
...  
Keyword(s):  
High Risk ◽  
Stereotactic Radiosurgery ◽  
Significant Risk ◽  
Venous Drainage ◽  
Significant Risk Factor ◽  
Low Risk ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Institutional Experience ◽  
Cortical Venous Drainage

OBJECTIVEAggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated.METHODSThe authors evaluated their institutional experience with SRS for dAVFs with CVD for the period from 1991 to 2016, assessing angiographic outcomes and posttreatment hemorrhage rates. They subsequently pooled their results with those published in the literature and stratified the results based on the mode of clinical presentation.RESULTSIn an institutional cohort of 42 dAVFs with CVD treated using SRS, there were no complications or hemorrhages after treatment in 19 patients with nonaggressive dAVFs, but there was 1 radiation-induced complication and 1 hemorrhage among the 23 patients with aggressive dAVFs. In pooling these cases with 155 additional cases from the literature, the authors found that the hemorrhage rate after SRS was significantly lower among the patients with nonaggressive dAVFs (0% vs 6.8%, p = 0.003). Similarly, the number of radiation-related complications was 0/124 in nonaggressive dAVF cases versus 6/73 in aggressive dAVF cases (p = 0.001). The annual rate of hemorrhage after SRS for aggressive fistulas was 3.0% over 164.5 patient-years, whereas none of the nonaggressive fistulas bled after radiosurgery over 279.4 patient-years of follow-up despite the presence of CVD.CONCLUSIONSCortical venous drainage is thought to be a significant risk factor in all dAVFs. In the institutional experience described here, SRS proved to be a low-risk strategy associated with a very low risk of subsequent hemorrhage or radiation-related complications in nonaggressive dAVFs with CVD.

scholarly journals Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data

2009 ◽  
Vol 26 (5) ◽  
pp. E14 ◽  
Author(s):  
Gregory J. Zipfel ◽  
Manish N. Shah ◽  
Daniel Refai ◽  
Ralph G. Dacey ◽  
Colin P. Derdeyn
Keyword(s):  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Risk Groups ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

This article presents a modification to the existing classification scales of intracranial dural arteriovenous fistulas based on newly published research regarding the relationship of clinical symptoms and outcome. The 2 commonly used scales, the Borden-Shucart and Cognard scales, rely entirely on angiographic features for categorization. The most critical anatomical feature is the identification of cortical venous drainage (CVD; Borden-Shucart Types II and III and Cognard Types IIb, IIa + b, III, IV, and V), as this feature identifies lesions at high risk for future hemorrhage or ischemic neurological injury. Yet recent data has emerged indicating that within these high-risk groups, most of the risk for future injury is in the subgroup presenting with intracerebral hemorrhage or nonhemorrhagic neurological deficits. The authors have defined this subgroup as symptomatic CVD. Patients who present incidentally or with symptoms of pulsatile tinnitus or ophthalmological phenomena have a less aggressive clinical course. The authors have defined this subgroup as asymptomatic CVD. Based on recent data the annual rate of intracerebral hemorrhage is 7.4–7.6% for patients with symptomatic CVD compared with 1.4–1.5% for those with asymptomatic CVD. The addition of asymptomatic CVD or symptomatic CVD as modifiers to the Borden-Shucart and Cognard systems improves their accuracy for risk stratification of patients with high-grade dural arteriovenous fistulas.

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