scholarly journals Endovascular Treatment of Cervical Giant Perimedullary Arteriovenous Fistulas

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 141-149 ◽  
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.

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

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.

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 88-92
Author(s):  
N. Kuwayama ◽  
S. Endo ◽  
M. Kubo ◽  
T. Akai ◽  
A. Takaku
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Dural Arteriovenous Fistulas ◽  
The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

scholarly journals Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course

2017 ◽  
Vol 19 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Jesús A. Morales-Gómez ◽  
Vicente V. Garza-Oyervides ◽  
José A. Arenas-Ruiz ◽  
Mariana Mercado-Flores ◽  
C. Guillermo Elizondo-Riojas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Clinical Course ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Unusual Presentation ◽  
Arteriovenous Fistulas ◽  
Pial Arteriovenous Fistula ◽  
Ventricular Shunting

Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.

scholarly journals Embolization of Vascular Malformations in Head and Neck Regions

2004 ◽  
Vol 10 (1) ◽  
pp. 37-46 ◽  
Author(s):  
A. Churojana ◽  
P. Chiewwit ◽  
A. Chuangsuwanich ◽  
C. Aojanepong ◽  
O. Chawalaparit ◽  
...  
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Flow Characteristics ◽  
Primary Treatment ◽  
Bleeding Complications ◽  
Venous Malformations ◽  
Alcohol Injection ◽  
Direct Puncture

The purpose of this study is to determine the effectiveness of embolization of each type of vascular malformation. Thirty three patients with a diagnosis of vascular malformations in head and neck regions who were treated by embolization at Siriraj Hospital, Thailand, between 1997–2002 were reviewed retrospectively. There were 19 arterio venous malformations (AVMs), two arteriolar-capillary types, ten venous malformations, one veno-lymphatic malformation and one mixed capillary and venous types. The goal of treatment is to restore function and to prevent bleeding complications with particularly good cosmetic results. The technique and therapeutic agents depended on the types and flow characteristics of each malformation. Transarterial embolization with N-butyl cyanoacrylate were used in AVMs, unless no arterial route approach, then direct puncture was tried. This was carried out in five patients with AVMs. Polyvinyl alcohol was used in two capillary lesions. All venous malformations were treated by absolute alcohol injection, percutaneously. All had good outcome without serious complications. Two patients had further plastic surgery, one was AVM of eyelid and the other was facial venolymphatic malformation. Embolization is considered to be the primary treatment by eradication of those abnormal vessels directly at the target, whereas delayed plastic surgery may be needed later.

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

2009 ◽  
Vol 3 (6) ◽  
pp. 501-506 ◽  
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.

scholarly journals Transvenous Approach to Intracranial Dural Arteriovenous Fistula (Cognard V): A Treatment Option

2011 ◽  
Vol 17 (1) ◽  
pp. 108-114 ◽  
Author(s):  
S. Aixut Lorenzo ◽  
A. Tomasello Weitz ◽  
J. Blasco Andaluz ◽  
L. Sanroman Manzanera ◽  
J.M. Macho Fernández
Keyword(s):  
Endovascular Treatment ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Complete Disappearance ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Collateral Arteries ◽  
Dural Arteriovenous Fistulas ◽  
Type V ◽  
Transvenous Approach

The endovascular technique is the gold standard treatment in dural arteriovenous fistulas. Due to the limited number of series published it is difficult to create rigid guidelines in terms of the best endovascular treatment approach. Treatment must be tailored to each particular case, but it is important to keep in mind that the possibility of treating a type V dAVF by the transvenous approach should not be discarded. In selected cases the transvenous approach may be helpful to increase the chance of success in the endovascular treatment of type V dAVF. We describe a patient in whom the first arterial treatment failed to achieve occlusion of the fistulous point with the glue. Clinical symptoms improved due to the diminished flow at the fistula after the first embolization but as soon as collateral arteries were recruited by the fistula, spinal cord venous drainage impairment led to symptoms recurrence. Transvenous access allowed us to close the fistula completely in one only session with a complete disappearance of the pathologically inverted perimedullary venous flow.

scholarly journals Delayed and incomplete treatment may result in dural fistula development in children with Vein of Galen malformation

2017 ◽  
Vol 24 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Dan Meila ◽  
Cynthia Schmidt ◽  
Katharina Melber ◽  
Dominik Grieb ◽  
Cornelius Jacobs ◽  
...  
Keyword(s):  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Treatment Timing ◽  
Arteriovenous Fistulas ◽  
Considerable Impact ◽  
Embolic Materials ◽  
Proximal Occlusion ◽  
Transvenous Approach ◽  
First Time ◽  
Incomplete Treatment

The association of dural arteriovenous fistulas (DAVF) in children with Vein of Galen malformation (VGM) has recently been reported for the first time. In a larger series of cases treated with transarterial NBCA embolization, 30% had DAVF. We wanted to analyze the development of DAVF in our cohort of children with VGM and to evaluate whether their occurrence depends on different treatment timing and embolic materials. We analyzed 43 VGM cases treated with a combined transarterial and transvenous approach between 2003 and 2016. In our early series until 2011, we used coils solely in 21 children. Since 2012, 22 children were treated with the combination of coils and Onyx. In the early series treated with coils solely, no case presented initially with or developed DAVF over time on follow-up angiograms. In our recent series we found four cases (9%) with DAVF. In two patients (5%), DAVF were found on the initial angiogram. Both patients presented at our department at age >2 years and were not treated elsewhere before. One patient (2%) presented at our department with too proximal occlusion of arterial feeders performed at another institution before. Only one patient (2%) developed DAVF in our department after the transarterial use of Onyx. Interestingly, this child did not develop DAVF as long as we used coils solely and his DAVF was localized exactly where an Onyx cast was identified. In conclusion, delayed and incomplete treatment may have a considerable impact on the occurrence of DAVF in VGM.

Transvenous Coil Embolization of an Intraorbital Arteriovenous Fistula

Neurosurgery ◽  
2012 ◽  
Vol 72 (1) ◽  
pp. E130-E134 ◽  
Author(s):  
Richard W. Williamson ◽  
Andrew F. Ducruet ◽  
R. Webster Crowley ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Coil Embolization ◽  
Ophthalmic Artery ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Rare Type ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Detachable Coils ◽  
Endovascular Coil Embolization ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND AND IMPORTANCE: Purely intraorbital arteriovenous fistulas (AVFs), which are rare vascular malformations that clinically mimic carotid-cavernous fistulas (CCFs), involve a fistula from the ophthalmic artery to 1 of the draining ophthalmic veins. We describe a case of an intraorbital AVF treated with transvenous endovascular coil embolization via the inferior petrosal sinus (IPS) route and review the literature on this rare entity. CLINICAL PRESENTATION: An 81-year-old woman sought treatment after 7 days of progressive left-sided visual acuity loss, chemosis, and lateral rectus palsy. Magnetic resonance imaging demonstrated dilated vascularity in the left orbit raising suspicions for a CCF. Cerebral angiography showed a purely intraorbital AVF with a fistula between the left ophthalmic artery and superior ophthalmic vein (SOV). Transvenous selective catheterization of the fistula was performed by successfully navigating the ipsilateral IPS to the cavernous sinus and SOV. The fistula was then embolized using detachable coils. The patient was discharged the next day. Three weeks after embolization, her ocular symptoms and findings had resolved. CONCLUSION: Intraorbital AVFs are a rare type of AVF that can be treated by direct surgical ligation, transarterial embolization, or transvenous embolization. We successfully navigated the IPS, which is frequently stenotic or occluded secondary to chronically increased fistulous drainage, and utilized this route to embolize the fistula with detachable coils.

scholarly journals Embolization Tactics of Spinal Epidural Arteriovenous Fistulas

2021 ◽  
Author(s):  
Abdulrahman Hamad Al-Abdulwahhab ◽  
Yunsun Song ◽  
Boseong Kwon ◽  
Dae Chul Suh
Keyword(s):  
Clinical Outcomes ◽  
Preferential Flow ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Tertiary Hospital ◽  
Total Occlusion ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Before And After ◽  
Spinal Epidural

Purpose: Spinal epidural arteriovenous fistulas (SEDAVFs) show an epidural venous sac often with venous congestive myelopathy (VCM) due to intradural reflux at a remote level to which a transarterial approach would be difficult. We present 12 cases of SEDAVF with VCM and describe 3 main tactics for effective transarterial embolization.Materials and Methods: Among 152 patients with spinal vascular malformations diagnosed in our tertiary hospital between 1993 and 2019, 12 SEDAVF patients with VCM were included. Three different transarterial embolization tactics were applied according to the vascular configuration and microcatheter accessibility. We evaluated treatment results and clinical outcomes before and after treatment.Results: Transarterial embolization with glue (20–30%) was performed in all patients. The embolization tactics applied in 12 patients were preferential flow (n=2), plug-and-push (n=6), and filling of the venous sac (n=4). Total occlusion of the SEDAVF, including intradural reflux, was achieved in 11 (91.7%) of 12 patients, and partial occlusion was achieved in 1 patient. No periprocedural complications were reported. Spinal cord edema was improved in all patients for an average of 18 months after treatment. Clinical functional outcome in terms of the pain, sensory, motor, and sphincter scale and modified Rankin scores improved during a mean 25-month follow-up (6.3 vs. 3.3, P=0.002; 3.6 vs. 2.3, P=0.002, respectively).Conclusion: Endovascular treatment for 12 SEDAVF patients with VCM achieved a total occlusion rate of 91.7% without any periprocedural complication. The combined embolization tactics can block intradural reflux causing VCM, resulting in overall good clinical outcomes.

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