Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

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Foramen magnum dural arteriovenous fistula presenting with epilepsy

Interventional Neuroradiology ◽

10.1177/1591019915609783 ◽

2015 ◽

Vol 21 (6) ◽

pp. 724-727 ◽

Cited By ~ 8

Author(s):

Raoul Pop ◽

Monica Manisor ◽

Ziad Aloraini ◽

Salvatore Chibarro ◽

Francois Proust ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Clonic Seizure ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Venous Congestion ◽

Arteriovenous Fistulas ◽

Complex Anatomy ◽

Significant Clinical Improvement

Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy.

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Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.241 ◽

2006 ◽

Vol 4 (3) ◽

pp. 241-245 ◽

Cited By ~ 20

Author(s):

Timo Krings ◽

Volker A. Coenen ◽

Martin Weinzierl ◽

Marcus H. T. Reinges ◽

Michael Mull ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Vascular Malformations ◽

Venous Drainage ◽

Elevated Pressure ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulas ◽

Progressive Myelopathy ◽

Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

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Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas

Journal of Neurosurgery ◽

10.3171/2020.10.jns203604 ◽

2021 ◽

pp. 1-9

Author(s):

Alexis Guédon ◽

Jean-Pierre Saint-Maurice ◽

Cédric Thépenier ◽

Marc-Antoine Labeyrie ◽

Vittorio Civelli ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Transarterial Embolization ◽

Venous Drainage ◽

Consecutive Series ◽

Lateral Sinus ◽

Transvenous Embolization ◽

Imaging Data ◽

Major Treatment ◽

Related Mortality

OBJECTIVE Intracranial dural arteriovenous fistula (DAVF) is mainly treated with an endovascular approach. Two major treatment advances include transvenous embolization (TVE) with coils in 1989 and, more recently, transarterial embolization with Onyx. The aim of this study was to present a large monocentric series of patients with DAVF treated with TVE. This series reports more than 20 years of experience and describes the evolution of the medical management of these patients, as well as current indications for this treatment at the authors’ center. METHODS Consecutive patients treated for intracranial DAVFs with TVE from 1995 to 2018 were included. Clinical and imaging data were systematically collected. Univariate and multivariate analyses were performed to identify factors that were significantly associated with adverse clinical course or complications. RESULTS In this study of 136 patients with 142 DAVFs treated with TVE, the occlusion rate was 90%. The median length of follow-up was 11 months. The rate of permanent complications was 5.1%, and the procedure-related mortality rate was 1.5%. Procedure-related mortality was associated with extension of thrombosis that was observed early in our experience. The introduction of a postoperative anticoagulation regimen has drastically decreased the occurrence of this complication. Other minor complications included cochleovestibular syndrome after embolization of lateral sinus DAVF and oculomotor nerve damage after embolization of cavernous sinus DAVF. CONCLUSIONS TVE allows efficient occlusion of DAVF. It remains a valid option for DAVF located on a sinus that does not participate in normal venous drainage of the brain.

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Endovascular treatment evolution for pure intraorbital arteriovenous fistula: Three case reports and literature review

The Neuroradiology Journal ◽

10.1177/1971400917692163 ◽

2017 ◽

Vol 30 (2) ◽

pp. 151-159 ◽

Cited By ~ 6

Author(s):

Xianli Lv ◽

Wei Li ◽

Aihua Liu ◽

Ming Lv ◽

Chuhan Jiang

Keyword(s):

Arteriovenous Fistula ◽

Case Reports ◽

Treatment Options ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

The Past ◽

Nerve Sheath ◽

Recent Developments ◽

Blurry Vision ◽

Transvenous Approach

Background and importance Intraorbital arteriovenous fistulas (IOAVFs) are rare and cause eye redness, exophthalmos, blurry vision and bruit. Whereas in the past they were treated conservatively, surgically or transarterially, recent developments in transvenous embolization have improved their treatment. In this paper the authors report three cases of IOAVFs treated endovascularly and review the evolution of treatment options. Methods Three cases of purely IOAVF enrolled in our center were reported and a PubMed literature search was performed using “pure intraorbital arteriovenous fistula” and “arteriovenous fistula of the optic nerve sheath.” A total of 21 papers were reviewed in full, focusing primarily on the treatment and outcomes. Results A total of 26 patients were obtained, including our three patients and 23 patients reported in the literature. In nine patients treated conservatively, four spontaneous occlusions, one visual deterioration and four cases with unknown outcome were reported. In another 18 patients, 29 therapies (including five surgical treatment, 11 transarterial embolizations and 13 transvenous embolizations) were attempted and resulted in 12 cures, five visual deteriorations and one without reported outcome. More recently, transvenous embolization has become the mainstay of IOAVF treatment. Of the 21 patients assessed between 2000 and 2013, a transvenous approach was attempted in 13 patients; nine patients were cured without any adverse events. Conclusion Development and improvement of transvenous techniques are found to be safe and effective for patients with IOAVF.

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Transarterial Embolization of a Cervical Dural Arteriovenous Fistula

Interventional Neuroradiology ◽

10.1177/159101990601200404 ◽

2006 ◽

Vol 12 (4) ◽

pp. 313-318 ◽

Cited By ~ 3

Author(s):

S.A. Ansari ◽

J.P. Lassig ◽

E. Nicol ◽

B.G. Thompson ◽

J.J. Gemmete ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Transarterial Embolization ◽

Venous Drainage ◽

Acute Onset ◽

Drainage Patterns ◽

The Right ◽

Glue Embolization

We describe a case of a 75-year-old man who presented with acute onset of headache and subarachnoid hemorrhage and initial cerebral angiography was deemed “negative”. In retrospect, a faint contrast collection was present adjacent to the right vertebral artery at the C1 level suspicious for a small dural arteriovenous fistula (dAVF). Follow-up angiography with selective micro-catheter injections of the right vertebral artery and C1 radicular artery confirmed a complex dAVF with characteristically specific venous drainage patterns associated with a subarachnoid hemorrhage presentation. Subsequently, the cervical dAVF was treated with superselective glue embolization resulting in complete occlusion. Cervical dAVFs are extremely rare vascular causes of subarachnoid hemorrhage. Both diagnostic angiography and endovascular treatment of these lesions can be challenging, especially in an emergent setting, requiring selective evaluation of bilateral vertebral arteries and careful attention to their cervical segments. Although only a single prior case of a cervical dAVF presenting with subarachnoid hemorrhage has been successfully treated with embolization, modern selective transarterial techniques may allow easier detection and treatment of subtle pathologic arteriovenous connections.

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Dural arteriovenous fistulas at the craniocervical junction: a systematic review

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011775 ◽

2015 ◽

Vol 8 (6) ◽

pp. 648-653 ◽

Cited By ~ 23

Author(s):

Jingjing Zhao ◽

Feng Xu ◽

Jinma Ren ◽

Sunil Manjila ◽

Nicholas C Bambakidis

Keyword(s):

English Language ◽

Venous Drainage ◽

Craniocervical Junction ◽

Female Ratio ◽

Arteriovenous Fistulas ◽

Increased Risk ◽

Significant Difference ◽

Dural Arteriovenous Fistulas ◽

Complete Obliteration ◽

Feasible Alternative

BackgroundDural arteriovenous fistulas (DAVFs) at the craniocervical junction are uncommon but clinically important abnormalities.ObjectiveTo investigate the clinical characteristics of patients with DAVFs at the craniocervical junction and assess angiographic features associated with bleeding at presentation.MethodsWe systematically reviewed the literature and searched PubMed and EMBASE for all relevant English language articles published between 1980 and 2014. The clinical presentation, angiographic characteristics, and treatment were assessed. The clinical differences between a subarachnoid hemorrhage (SAH) group and a non-SAH group were statistically examined.ResultsFifty-six patients were identified after a review of the literature (mean age 55.6 years; male to female ratio=3:1). Twenty-one patients (37.5%) presented with hemorrhage including SAH and posterior fossa hemorrhage. There was no significant difference in patient age, sex, or location of the DAVF between the SAH group and the non-SAH group. Intracranial venous drainage was significantly associated with SAH (p<0.001). The presence of a varix was significantly associated with SAH (p=0.001). Open surgery had a significantly higher efficacy of initial complete obliteration than embolization (100% vs 71.4%, p<0.01).ConclusionsDAVFs at the craniocervical junction are rare lesions, which often present with hemorrhage. Intracranial venous drainage and a venous varix are associated with increased risk of SAH. Surgical interruption of the feeding arteries or draining veins is an effective and reliable method for treating DAVFs at the craniocervical junction. Embolization is a feasible alternative to surgery in the treatment of selective DAVFs.

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

The Neuroradiology Journal ◽

10.1177/19714009211042898 ◽

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.

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Nuances of transarterial and transvenous embolization of a large tentorial arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2019.2.focusvid.18674 ◽

2019 ◽

Vol 46 (Suppl_2) ◽

pp. V12

Author(s):

Lorenzo Rinaldo ◽

Waleed Brinjikji ◽

Leonardo Rangel-Castilla

Keyword(s):

Arteriovenous Fistula ◽

Pulsatile Tinnitus ◽

Transvenous Embolization ◽

Link Type ◽

Complete Obliteration ◽

History Of ◽

Transvenous Approach

An 80-year-old female presented with a long history of severe pulsatile tinnitus, vertigo, and decreased hearing. She was found to have a large right-sided tentorial arteriovenous fistula (AVF) with enlarged deep draining veins, including the vein of Rosenthal. The patient underwent Onyx embolization of the fistula via a combined transarterial and transvenous approach resulting in complete obliteration of the fistula. Her symptoms improved immediately after the procedure and at 6-months’ follow-up she was clinically asymptomatic with no evidence of residual fistula on neuroimaging. Transvenous embolization of AVF is at times necessary when transarterial access is not possible.The video can be found here: https://youtu.be/uOMHY7eaOoQ.

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Endovascular Treatment of Cervical Giant Perimedullary Arteriovenous Fistulas

Neurosurgery ◽

10.1227/neu.0b013e31822ec19e ◽

2011 ◽

Vol 70 (1) ◽

pp. 141-149 ◽

Cited By ~ 7

Author(s):

Alfredo Casasco ◽

Leopoldo Guimaraens ◽

Cagin Senturk ◽

Enrico Cotroneo ◽

Renato Gigli ◽

...

Keyword(s):

Endovascular Treatment ◽

Vascular Malformations ◽

Transarterial Embolization ◽

Cervical Region ◽

Motor Deficit ◽

Published Data ◽

Direct Puncture ◽

Arteriovenous Fistulas ◽

Proximal Occlusion ◽

Transvenous Approach

Abstract BACKGROUND Giant perimedullary arteriovenous fistulas (GPMAVFs) located in the cervical region are a rare pathology with distinctive characteristics. OBJECTIVE To evaluate clinical presentation and different endovascular treatment options of cervical GPMAVFs and review previously published data in the literature regarding cervical GPMAVFs. METHODS Six patients with cervical GPMAVFs were found in the spinal vascular malformations database of our group collected between 1990 and 2009. Endovascular techniques and treatment outcomes were evaluated and compared with other published series. RESULTS Clinical presentations were progressive motor deficit (5 patients), hematomyelia (1 patient), meningeal syndrome (1 patient), and respiratory arrest and gait apraxia (1 patient). Three patients were treated by the transarterial approach. One patient was treated by the transvenous approach due to previous embolizations resulting in a proximal occlusion and preventing a safe transarterial approach. A transvenous approach was used in another patient due to complex arterial anatomy. In 1 patient, direct percutaneous puncture of the venous pouch was necessary because of previous proximal occlusion of the arteries. All embolizations resulted in complete occlusions with clinical improvement, and there was no recanalization during a mean follow-up of 21 months. CONCLUSION Transarterial embolization of cervical GPMAVFs is safe and effective when it is done in highly experienced centers. Cervical GPMAVFs that cannot be accessed by the transarterial technique due to their complex angioarchitecture can be treated by transvenous embolization or direct puncture of the venous pouch.

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Endovascular management of complex superior sagittal sinus dural arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2019.2.focusvid.18687 ◽

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.

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