Embolization of dural arteriovenous fistula during twin pregnancy – A case report and literature review

2021 ◽  
pp. 159101992199139
Author(s):  
Daiichiro Ishigami ◽  
Satoshi Koizumi ◽  
Osamu Ishikawa ◽  
Masatake Toshimitsu ◽  
Takayuki Iriyama ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Twin Pregnancy ◽  
Case Reports ◽  
Transarterial Embolization ◽  
Treatment Strategies ◽  
Venous Drainage ◽  
Third Trimester ◽  
History Of ◽  
Primigravid Woman

Background Several literature reviews have suggested that pregnancy may trigger the formation of dural arteriovenous fistulae (DAVF). However, few case reports have described DAVF discovered during pregnancy, and treatment strategies remain largely unknown. Case description: A 28-year-old primigravid woman without any medical history of note presented to our hospital for natural twin conception. She started to feel left-sided pulsatile tinnitus in 23 weeks of gestation. Magnetic resonance imaging of the head raised suspicion of left cavernous sinus DAVF with leptomeningeal venous drainage. Considering the risk of intracerebral hemorrhage due to the increased cardiac output in the third trimester of a twin pregnancy, we performed transarterial embolization for the DAVF, which was successfully achieved without complications in 28 weeks of gestation. Tinnitus resolved immediately after the procedure, and the postoperative course proved uneventful. Both fetuses were safely delivered by cesarean section on 37 1/7 weeks of gestation. Conclusions We encountered a case of cavernous sinus DAVF during a twin pregnancy. This case suggests that hemodynamic shift due to pregnancy has potential to cause higher shunt flow in an arteriovenous fistula. The timing of treatment should be determined in consideration of the hemodynamic change in the course of pregnancy. If X-ray exposures and iodine contrast media are appropriately managed, endovascular intervention is one treatment option, even during pregnancy.

Tentorial Dural Arteriovenous Fistula Presenting with Various Visual Symptoms Related to Anterior and Posterior Visual Pathway Dysfunction: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 222-227 ◽  
Author(s):  
Goetz Benndorf ◽  
Stefanie Schmidt ◽  
Wolf-Peter Sollmann ◽  
Stefan-Nikolaus Kroppenstedt
Keyword(s):  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Visual Pathway ◽  
Sudden Onset ◽  
Left Vertebral Artery ◽  
Visual Symptoms ◽  
Meningeal Arteries ◽  
History Of ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented. CLINICAL PRESENTATION A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins. INTERVENTION Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination. CONCLUSION Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.

scholarly journals Transvenous Embolization for Dural Arteriovenous Shunt of the Cavernous Sinus

2007 ◽  
Vol 13 (4) ◽  
pp. 353-358 ◽  
Author(s):  
S. Kato ◽  
H. Ishihara ◽  
H. Nakayama ◽  
M. Fujii ◽  
H. Fujisawa ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Transarterial Embolization ◽  
Arteriovenous Shunt ◽  
Complete Disappearance ◽  
Transvenous Embolization ◽  
Arteriovenous Shunts

We describe the treatment and follow-up clinical symptoms and angiographic results in patients with dural arteriovenous fistula of the cavernous sinus treated by transvenous embolization (TVE). We have treated eight cases of dural arteriovenous fistula of the cavernous sinus by multi-staged TVE in two cases and TVE with sinus packing in six and three of six cases were treated with a combination of transarterial embolization. Multi-staged TVE was performed by occlusion from dangerous drainage veins to the cavernous sinus on several occasions. Angiographical results showed disappearance or reduction of the arteriovenous shunt in all cases. Six patients presented with ophthalmic symptoms and two had tinnitus. Six cases had complete disappearance of clinical symptoms after treatment. There was a deterioration of ocular movement in one patient treated by TVE with sinus packing. Multi-staged TVE was performed to reduce the coil volume for the packing of the cavernous sinus in two cases without cranial nerve palsy. Embolization, especially multi-staged TVE, was considered a good treatment to occlude arteriovenous shunts at the cavernous sinus without cranial nerve complications.

Spontaneous angiographic changes in venous drainage patterns related to symptom changes in patients with untreated cavernous sinus dural arteriovenous fistula

2015 ◽  
Vol 57 (11) ◽  
pp. 1153-1161 ◽  
Author(s):  
Jai Ho Choi ◽  
Kyung Il Jo ◽  
Keon Ha Kim ◽  
Pyoung Jeon ◽  
Je Young Yeon ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Drainage Patterns ◽  
Symptom Changes

Selective transvenous embolization of dural carotid—cavernous sinus fistulas with preservation of sylvian venous outflow

1998 ◽  
Vol 89 (5) ◽  
pp. 825-829 ◽  
Author(s):  
Mitsugu Nakamura ◽  
Norihiko Tamaki ◽  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
The Other ◽  
Oculomotor Nerve Palsy ◽  
Transvenous Embolization ◽  
Venous Outflow ◽  
Residual Shunt ◽  
Abducent Nerve Palsy

✓ A transvenous embolization technique in which normal cerebral venous drainage can be spared is described. Of 26 dural carotid—cavernous fistulas treated by the authors, the affected cavernous sinus received not only the shunted flow but also the sylvian venous drainage in three cases. Two patients presented with an abducent nerve palsy, and one with an oculomotor nerve palsy. Selective transvenous embolization of the fistulous portions of the affected cavernous sinus was achieved, with preservation of the sylvian venous outflow. Postembolization angiograms revealed complete occlusion of the fistula in one patient and only a small amount of residual shunt in the other two. One of these two underwent subsequent transarterial embolization, and the other was followed without additional treatment. The patients' symptoms resolved between 1 and 2 months posttreatment. Follow-up angiograms revealed that the remnant shunt had disappeared and the sylvian venous pathway had been preserved. The authors conclude that selective transvenous embolization of fistulous compartments in an affected sinus can be used to treat dural arteriovenous fistulas involving a cavernous sinus that also receives the sylvian venous outflow.

scholarly journals Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management

2015 ◽  
Vol 122 (4) ◽  
pp. 883-903 ◽  
Author(s):  
Björn Spittau ◽  
Diego San Millán ◽  
Saad El-Sherifi ◽  
Claudia Hader ◽  
Tejinder Pal Singh ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Case Reports ◽  
Transarterial Embolization ◽  
Venous Anatomy ◽  
Hypoglossal Canal ◽  
Arteriovenous Fistulas ◽  
Small Series ◽  
Dural Arteriovenous Fistulas ◽  
Type 3

Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as various entities (for example, “marginal sinus DAVFs”) solely described in case reports or small series. In this in-depth review of HCDAVF, the authors describe clinical and imaging findings, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by their own cases (120 cases total). Further, the involved craniocervical venous anatomy with variable venous anastomoses is summarized. Hypoglossal canal DAVFs consist of a fistulous pouch involving the anterior condylar confluence and/or anterior condylar vein with a variable intraosseous component. Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). Understanding the complex venous anatomy is crucial for planning alternative approaches if standard transjugular access is impossible. Transarterial embolization or surgical disconnection (morbidity 13.3%–16.7%) should be reserved for Type 3 HCDAVFs or lesions with poor venous access. A conservative strategy could be appropriate in Type 1 HCDAVF for which spontaneous regression (5.8%) may be observed.

scholarly journals Spontaneous rupture of the uterus following salpingectomy: a case report and literature review

2019 ◽  
Vol 47 (10) ◽  
pp. 5328-5336
Author(s):  
Zhifen Hua ◽  
Minjun Wu
Keyword(s):  
Literature Review ◽  
Case Reports ◽  
Third Trimester ◽  
Interstitial Pregnancy ◽  
Spontaneous Uterine Rupture ◽  
Close Observation ◽  
History Of ◽  
Laparoscopic Salpingectomy ◽  
Timely Treatment ◽  
Better Than

Laparoscopic salpingectomy (LPSC) is the main treatment for ectopic pregnancy, which leads to spontaneous uterine rupture (UR) during pregnancy. We report the characteristics of a woman who had spontaneous UR during pregnancy with a history of salpingectomy. We experienced a 31-year-old woman with a UR in pregnancy with a history of LPSC twice. The patient had a successful pregnancy. We also performed a literature review including cases with spontaneous UR after LPSC. Twenty-seven case reports of 48 women were included in our review. Thirty-five (83.33%, 35/42) women previously received LPSC and 15 (31.25%) developed interstitial pregnancies. The interval between pregnancy and the last surgery did not affect the frequency of interstitial pregnancy and gestational age. Fetal outcomes in patients with UR at the third trimester were better than those at the first and second trimesters. We suggest that close observation and timely treatment by experienced clinicians lead to good outcomes of pregnant women with suspected UR.

scholarly journals Selective transvenous embolization of dural carotid-cavernous sinus fistulas with preservation of sylvian venous outflow

1998 ◽  
Vol 5 (4) ◽  
pp. E13
Author(s):  
Mitsugu Nakamura ◽  
Norihiko Tamaki ◽  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Additional Treatment ◽  
The Other ◽  
Oculomotor Nerve Palsy ◽  
Transvenous Embolization ◽  
Venous Outflow ◽  
Abducent Nerve Palsy

A transvenous embolization technique that spares normal cerebral venous drainage is described. Of 26 dural carotid-cavernous fistulas treated by the authors, in three cases the affected cavernous sinus was supplied by not only the shunt flow but also the sylvian venous drainage. Two patients presented with an abducent nerve palsy and one with an oculomotor nerve palsy in whom selective transvenous embolization of the fistulous portions of the affected cavernous sinus was achieved while preserving of the sylvian venous outflow. Posttransvenous embolization angiograms showed complete occlusion of the fistula in one patient and only small residual shunts in the other two; one underwent subsequent transarterial embolization, whereas the other was followed without additional treatment. The patients' symptoms disappeared between 1 and 2 months posttreatment. Follow-up angiograms revealed that the remnant shunt had disappeared and that the sylvian venous pathway had been preserved. The authors conclude that although the condition is uncommon it is important to recognize that a dural carotid-cavernous sinus fistula, which receives significant sylvian venous outflow, can be treated successfully by selective transvenous embolization of the fistulous compartments in an affected sinus.

Torcular dural arteriovenous fistula treated via stent placement and angioplasty in the affected straight and transverse sinuses: case report

2015 ◽  
Vol 122 (5) ◽  
pp. 1208-1213 ◽  
Author(s):  
Shigeki Takada ◽  
Fumiaki Isaka ◽  
Takuya Nakakuki ◽  
Yuto Mitsuno ◽  
Takaaki Kaneko
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Placement ◽  
Dural Arteriovenous Fistula ◽  
Treatment Strategies ◽  
Venous Drainage ◽  
Shunt Flow ◽  
Therapeutic Goals ◽  
Closed Cell ◽  
Complete Obliteration ◽  
Dural Wall

The successful obliteration of torcular dural arteriovenous fistula (DAVF) with a diffuse shunt in the affected sinus may require complex treatment strategies. Therapeutic goals include the preservation of normal venous drainage and complete obliteration of shunt flow. The authors report the case of a torcular DAVF. The treatment of this type of AVF may require a combined approach with transarterial and transvenous embolization, open surgery, or radiosurgery and is associated with many problems. Stent placement and angioplasty in the affected sinus result in compression of the fistulous dural wall of the sinus and decrease shunt flow. In cases in which there is a diffuse shunt in the affected sinus and no evident shunt point, such as in AVFs involving venous pouches and parasinuses, sealing the fistula orifice with self-expandable stents and angioplasty (balloon inflation) is considered the best treatment option to preserve normal cerebral venous sinus drainage and obliterate shunt flow. In such cases, the authors recommend using one or more self-expandable and closed-cell stents and using angioplasty to avoid endoleakage into the gap between the stent graft and the vessel wall.

scholarly journals Transarterial embolization of an internal maxillary artery arteriovenous fistula presenting with pulsatile tinnitus

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V7
Author(s):  
Waleed Brinjikji ◽  
Harry J. Cloft ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel-Castilla ◽  
Pearse P. Morris
Keyword(s):  
Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Pulsatile Tinnitus ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulae ◽  
Common Presentation ◽  
Single Hole ◽  
History Of

Arteriovenous fistulae of the internal maxillary artery are exceedingly rare, with less than 30 cases reported in the literature. Most of these lesions are congenital, iatrogenic, or posttraumatic. The most common presentation of internal maxillary artery fistulae is pulsatile tinnitus and headache. Because these lesions are single-hole fistulae, they can be easily cured with endovascular techniques. The authors present a case of a patient who presented to their institution with a several-year history of pulsatile tinnitus who was found to have an internal maxillary artery arteriovenous fistula, which was treated endovascularly with transarterial coil and Onyx embolization.The video can be found here: https://youtu.be/fDZVMMwpwRc.

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

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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