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

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.

Download Full-text

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

Interventional Neuroradiology ◽

10.1177/1591019919874571 ◽

2019 ◽

Vol 26 (2) ◽

pp. 170-177

Author(s):

Keisuke Yoshida ◽

Shinsuke Sato ◽

Tatsuya Inoue ◽

Bikei Ryu ◽

Shogo Shima ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Arteriovenous Fistula ◽

Vascular Malformations ◽

Transarterial Embolization ◽

Venous Drainage ◽

Craniocervical Junction ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Complete Obliteration ◽

Transvenous Approach

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.

Download Full-text

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000228 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S32-S41 ◽

Cited By ~ 19

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.

Download Full-text

Transvenous embolization for a purely intraorbital arteriovenous fistula

Journal of Neurosurgery ◽

10.3171/jns.2005.103.4.0756 ◽

2005 ◽

Vol 103 (4) ◽

pp. 756-759 ◽

Cited By ~ 17

Author(s):

Jun Deguchi ◽

Makoto Yamada ◽

Ryusuke Ogawa ◽

Toshihiko Kuroiwa

Keyword(s):

Arteriovenous Malformation ◽

Arteriovenous Fistula ◽

Visual Function ◽

Clinical Management ◽

Ophthalmic Artery ◽

Transvenous Embolization ◽

Content Type ◽

Arteriovenous Fistulas ◽

Fine Print

✓ Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

Download Full-text

Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report

Journal of Anesthesia and Anesthetic Drugs ◽

10.54289/jaad2100105 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Md Moshiur Rahman

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

External Jugular Vein ◽

Middle Income ◽

Arteriovenous Fistulas ◽

Middle Income Countries ◽

Dural Arteriovenous Fistulas ◽

Superior Longitudinal Sinus ◽

Transvenous Approach

Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.

Download Full-text

Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.2.peds08469 ◽

2009 ◽

Vol 3 (6) ◽

pp. 501-506 ◽

Cited By ~ 6

Author(s):

R. Webster Crowley ◽

Avery J. Evans ◽

Mary E. Jensen ◽

Neal F. Kassell ◽

Aaron S. Dumont

Keyword(s):

Endovascular Treatment ◽

Transarterial Embolization ◽

Treatment Options ◽

Endovascular Techniques ◽

Vascular Abnormalities ◽

Arteriovenous Fistulas ◽

The Past ◽

Endovascular Approach ◽

Embolic Materials ◽

Extensive Surgery

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.

Download Full-text

Surgical Transvenous Embolization of a Carotid-Cavernous Dural Fistula with Cortical Drainage via a Petrosal Vein: Two Technical Case Reports

Neurosurgery ◽

10.1097/00006123-200206000-00036 ◽

2002 ◽

Vol 50 (6) ◽

pp. 1380-1384 ◽

Cited By ~ 1

Author(s):

Tsuyoshi Hara ◽

Jun-ichiro Hamada ◽

Yutaka Kai ◽

Yukitaka Ushio

Keyword(s):

Case Reports ◽

Transvenous Embolization ◽

Guglielmi Detachable Coils ◽

Dural Fistula ◽

Petrosal Vein ◽

Ocular Symptoms ◽

Detachable Coils ◽

Endovascular Approach ◽

Transvenous Approach ◽

Fistula Site

Abstract OBJECTIVE AND IMPORTANCE We present two interesting cases involving carotid-cavernous dural fistulae draining only or predominantly into the petrosal vein after previous incomplete, complicated, endovascular treatments. Transvenous embolization with Guglielmi detachable coils, via the petrosal vein, during surgical exposure completely obliterated the fistulae. CLINICAL PRESENTATION A 64-year-old man manifesting left ocular symptoms after incomplete embolization of a left carotid-cavernous dural fistula and a 56-year-old woman manifesting left hemiparesis after complicated embolization of a right carotid-cavernous dural fistula were referred to our hospital. A percutaneous transvenous approach was attempted in both cases, but the catheter could not reach the fistula site. A combined open surgical and endovascular approach was then used. INTERVENTION The hemispheric branch of the petrosal vein was exposed via a retromastoid craniectomy. The catheter was then directly introduced into the hemispheric branch, followed by navigation into the fistula site. The fistula was completely embolized with Guglielmi detachable coils. CONCLUSION The technique of surgical transvenous embolization via a petrosal vein is a valuable alternative for the treatment of carotid-cavernous dural fistulae that drain only or predominantly into the petrosal vein, when the percutaneous transvenous route is not accessible.

Download Full-text

Transvenous Embolization of Dural Arteriovenous Fistulas of the Hypoglossal Canal: Report of Three Cases and Review of the Literature

Interventional Neurology ◽

10.1159/000488500 ◽

2018 ◽

Vol 7 (6) ◽

pp. 315-322

Author(s):

Alejandro Santillan ◽

Justin Schwarz ◽

Athos Patsalides

Keyword(s):

Transvenous Embolization ◽

Endovascular Management ◽

Review Of The Literature ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Transvenous Approach

In this article, we report three cases of dural arteriovenous fistulas of the hypoglossal canal treated via transvenous approach. We also perform a review of the literature on the endovascular management of this type of lesions with particular attention to the dangerous extracranial-intracranial anastomoses that can occur at this level.

Download Full-text

Emerging agents and regimens for AML

Journal of Hematology & Oncology ◽

10.1186/s13045-021-01062-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Hongtao Liu

Keyword(s):

Myeloid Leukemia ◽

Treatment Options ◽

Treatment Resistance ◽

Therapeutic Agents ◽

Mechanisms Of Resistance ◽

Car T Cells ◽

The Past ◽

Car T ◽

Recent Developments ◽

Molecular Landscape

AbstractUntil recently, acute myeloid leukemia (AML) patients used to have limited treatment options, depending solely on cytarabine + anthracycline (7 + 3) intensive chemotherapy and hypomethylating agents. Allogeneic stem cell transplantation (Allo-SCT) played an important role to improve the survival of eligible AML patients in the past several decades. The exploration of the genomic and molecular landscape of AML, identification of mutations associated with the pathogenesis of AML, and the understanding of the mechanisms of resistance to treatment from excellent translational research helped to expand the treatment options of AML quickly in the past few years, resulting in noteworthy breakthroughs and FDA approvals of new therapeutic treatments in AML patients. Targeted therapies and combinations of different classes of therapeutic agents to overcome treatment resistance further expanded the treatment options and improved survival. Immunotherapy, including antibody-based treatment, inhibition of immune negative regulators, and possible CAR T cells might further expand the therapeutic armamentarium for AML. This review is intended to summarize the recent developments in the treatment of AML.

Download Full-text

Microsurgical treatment of a posterior fossa arteriovenous malformation initially mistaken for a dural arteriovenous fistula: avoidance of near disaster

Neurosurgical Focus: Video ◽

10.3171/2020.10.focvid2047 ◽

2021 ◽

Vol 4 (1) ◽

pp. V7

Author(s):

Brian M. Howard ◽

Daniel L. Barrow

Keyword(s):

Arteriovenous Malformation ◽

Arteriovenous Fistula ◽

Posterior Fossa ◽

Arteriovenous Malformations ◽

Dural Arteriovenous Fistula ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Fatal Hemorrhage ◽

Hemorrhagic Complications ◽

Dural Arteriovenous Fistulas

Many brain arteriovenous malformations (AVMs) derive dural blood supply, while 10%–15% of dural arteriovenous fistulas (dAVFs) have pial arterial input. To differentiate between the two is critical, as treatment of these entities is diametrically opposed. To treat dAVFs, the draining vein(s) is disconnected from feeding arteries, which portends hemorrhagic complications for AVMs. The authors present an operative video of a subtle cerebellar AVM initially treated as a dAVF by attempted embolization through dural vessels. The lesion was subsequently microsurgically extirpated. The authors show a comparison case of an AVM mistaken for a dAVF and transvenous embolization that resulted in a fatal hemorrhage.The video can be found here: https://youtu.be/eDeiMrGoE0Q

Download Full-text

Dural Arteriovenous Fistulas: Unusual Access Routes in the Elderly

Interventional Neuroradiology ◽

10.1177/159101990501100411 ◽

2005 ◽

Vol 11 (4) ◽

pp. 377-381 ◽

Cited By ~ 1

Author(s):

G. Andrade ◽

R. Marques ◽

N. Brito Pires ◽

C. Abath

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Sinus Thrombosis ◽

The Elderly ◽

Venous Access ◽

Transvenous Embolization ◽

Superior Ophthalmic Vein ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Detachable Coils

Transvenous embolization is effective in the treatment of an intracranial dural arteriovenous fistula (DAVF). Retrograde venous access to the fistula may be limited by associated sinus thrombosis, as in the two cases here reported. Unusual curative access routes were performed: direct superior ophthalmic vein puncture and through a small craniectomy, packing the sinus with detachable coils. When traditional routes proved impossible, unusual access routes must be devised.

Download Full-text