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.

Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 21-27 ◽  
Author(s):  
Hyun Ho Jung ◽  
Jong Hee Chang ◽  
Kum Whang ◽  
Jin Soo Pyen ◽  
Jin Woo Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Gamma Knife Surgery ◽  
Low Flow ◽  
Close Monitoring ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.

scholarly journals Onyx Migration in the Endovascular Management of Intracranial Dural Arteriovenous Fistulas

2009 ◽  
Vol 15 (3) ◽  
pp. 301-308 ◽  
Author(s):  
H. Wang ◽  
X. Lv ◽  
C. Jiang ◽  
Y. Li ◽  
Z. Wu ◽  
...  
Keyword(s):  
Transarterial Embolization ◽  
Middle Meningeal Artery ◽  
Visual Disturbance ◽  
Embolic Agent ◽  
Occipital Artery ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Dural Arteriovenous Fistulas ◽  
Chest X Ray ◽  
The Right

Onyx migration in the endovascular treatment of dural arteriovenous fistulas (dural AVFs) is uncommon. We describe five cases of Onyx migration to the heart and draining vein and its avoidance. Between February 2007 and August 2008, Onyx migration was encountered in five patients with dural AVFs treated endovascularly at our institute. Procedures performed under general anesthesia consisted of two arterial approaches and three venous approaches. Two patients with dural AVFs involving the transverse-sigmoid sinus were treated by transarterial embolization using Onyx-18 via the occipital artery and the posterior branch of the middle meningeal artery, respectively. A piece of Onyx was found in the right ventricle on post-embolization chest X-ray film in both patients, one developed tricuspid valve dysfunction requiring thoracic surgery and one was asymptomatic. The other three patients were treated with a combination of Onyx (34 or 18) and coils transvenously with venous Onyx migration leading to draining vein occlusion, one with dural AVF involving the tentorium died from venous rupture, two patients with bilateral dural AVFs of the cavernous sinus (one with deterioration of ocular symptoms and one without symptoms). Postoperative digital subtraction angiography confirmed the elimination of dural AVF in one patient, and residual fistulae in three patients. The follow-up study ranging from two to nine months (average, 4.5 months). Three patients recovered to their full activities, while one had visual disturbance. Although Onyx has been considered a controllable embolic agent, its migration to other locations causing clinical deterioration can occur. This problem should be noted and prevented.

scholarly journals Transarterial embolization of an anterior fossa cranial base dural arteriovenous fistula

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Brian Lee ◽  
Vivek A. Mehta ◽  
Arun P. Amar ◽  
Matthew S. Tenser ◽  
William J. Mack
Keyword(s):  
Ophthalmic Artery ◽  
Transarterial Embolization ◽  
Cranial Base ◽  
Anterior Cranial Fossa ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Endovascular Approach ◽  
Anterior Fossa ◽  
Cranial Fossa ◽  
Embolic Materials

Open surgical disconnection has long been the treatment of choice for dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa. However, advanced patient age and the presence of medical comorbidities can substantially increase the risk of craniotomy and favor a less invasive endovascular approach. Optimal positioning within the distal ophthalmic artery, beyond the origin of the central retinal branch, is achievable using current microcatheter technology and embolic materials. Here we present the case of an 88-year-old female with an incidentally discovered dAVF of the anterior cranial fossa. Angiographic cure was achieved with one-stage Onyx embolization.The video can be found here: http://youtu.be/KVE0fUIECQM.

scholarly journals Endovascular coil embolization of a spinal epidural arteriovenous fistula with associated cord compression from an enlarging venous varix

2015 ◽  
Vol 21 (6) ◽  
pp. 738-741 ◽  
Author(s):  
Dale Ding ◽  
Robert M Starke ◽  
David Manka ◽  
R Webster Crowley ◽  
Kenneth C Liu
Keyword(s):  
Coil Embolization ◽  
Venous Drainage ◽  
Cord Compression ◽  
Technical Note ◽  
Arteriovenous Fistulas ◽  
Endovascular Coil Embolization ◽  
The Right ◽  
Spinal Epidural ◽  
Venous Varix

Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20 × 13 mm2 contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26 × 16 mm2. The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF.

scholarly journals A case of two pial arteriovenous fistulas with giant venous pouches treated by endovascular coil embolization: Therapy with and without anticoagulation

2015 ◽  
Vol 22 (1) ◽  
pp. 97-100 ◽  
Author(s):  
Wenjun Ji ◽  
Aihua Liu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Intracranial Hemorrhage ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Anticoagulation Therapy ◽  
Blood Stasis ◽  
Left Middle Cerebral Artery ◽  
Arteriovenous Fistulas ◽  
Endovascular Occlusion ◽  
Endovascular Coil Embolization

Background Endovascular coil embolization of pial arteriovenous fistulas (AVF) has been reported as an effective treatment. However, venous thrombosis and intracranial hemorrhage developing after endovascular occlusion of a pial AVF have not been adequately reported. Case description A 37-year-old man presented with left middle cerebral artery (MCA) AVF and right posterior cerebral artery (PCA) AVF with giant venous pouches. Staged endovascular coil embolization was performed. The MCA AVF was completely occluded by coils at the first stage. Intravenous heparin (3000 IU) was administered during the procedure, and then low molecular weight heparin (subcutaneous injection, 0.4 mL/12 hours) was administered for two days. The PCA AVF was near completely occluded by coils without anticoagulation therapy at the second stage. Rapid progressive venous thrombosis and intracranial hemorrhage were confirmed by computerized tomography brain scan postoperatively, and the patient was then transferred to the neurological intensive care unit for further treatment. Finally, the patient recovered well at the five-month follow-up. Conclusions Endovascular occlusion of a high-flow pial AVF with a giant venous pouch resulting in significant blood stasis could precipitate thrombosis in the venous system. Further studies are required to establish whether anticoagulation therapy is necessary.

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.

INITIAL EXPERIENCE WITH BIOACTIVE CERECYTE DETACHABLE COILS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 799-806 ◽  
Author(s):  
Erol Veznedaroglu ◽  
Christopher J. Koebbe ◽  
Adnan Siddiqui ◽  
Robert H. Rosenwasser
Keyword(s):  
Coil Embolization ◽  
Unruptured Aneurysms ◽  
Handling Characteristics ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Mean Size ◽  
Endovascular Coil Embolization ◽  
The Mean ◽  
Permanent Neurological Deficit

Abstract OBJECTIVE Despite proven safety of endovascular coil embolization of intracranial aneurysms, the potential need for retreatment remains criticized. The goal of this prospective study was to assess the safety, durability, and effect on recanalization rates of the Cerecyte (Micrus Corp., Sunnyvale, CA) bioactive coil. METHODS Two hundred twelve ruptured and unruptured aneurysms in 176 patients were prospectively enrolled in a database registry during a 12-month period. Adverse clinical outcomes directly attributed to the use of the Cerecyte coil were documented. Angiographic outcomes were determined immediately after coil embolization and during follow-up studies. All patients who received stent assistance or a non-Cerecyte coil were excluded. Two independent endovascular surgeons reviewed follow-up films. Any discrepancy was deemed a recurrence. RESULTS After exclusion criteria, 81 patients with 89 aneurysms were available for a minimum of 6 months of follow-up. Of those 89 aneurysms, 65% were ruptured aneurysms and were treated in the acute setting. The mean size of the aneurysm was 7 mm. The mean angiographic follow-up period was 11.2 months. Recurrences requiring retreatment as a result of dome filling were identified in six aneurysms (6.7%). Four aneurysms (4%) developed compaction of more than 20%, which was defined as interstitial filling of the fundus. There was one thromboembolic event leading to permanent neurological deficit. No cases of chemical meningitis or delayed hydrocephalus occurred. CONCLUSION The Cerecyte bioactive coil seems to be safe and effective for use in both ruptured and unruptured aneurysms. The bioactive polymer within the coils allows similar handling characteristics of a bare platinum coil. Studies to assess long-term outcomes with direct comparison to platinum coils and alternative bioactive coils are warranted.

Cervical spine dural arteriovenous fistula presenting with congestive myelopathy of the conus

2009 ◽  
Vol 11 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Sasikhan Geibprasert ◽  
Sirintara Pongpech ◽  
Pakorn Jiarakongmun ◽  
Timo Krings
Keyword(s):  
Cervical Spine ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Imaging Findings ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Arteriovenous Shunts ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (DAVFs) are the spinal vascular malformations that are encountered most often, and they are usually encountered in the lower thoracic region. Cervical spine DAVFs are exceedingly rare and may be difficult to differentiate from radicular arteriovenous malformations, epidural arteriovenous shunts, or perimedullary AVFs. Typical angiographic findings in spinal DAVFs include a slow-flow shunt with converging feeding vessels from radiculomeningeal arteries draining via a radicular vein centripetally into perimedullary veins. The MR imaging findings such as spinal cord edema and perimedullary dilated vessels may be used to direct the spinal angiography that is needed to localize and classify the shunt. When the shunt is distant from the pathological imaging findings, the diagnosis may be difficult to establish, especially when the shunt is present at an atypical location such as the cervical spine. The authors present the case of a 51-year-old man presenting with lower thoracic and conus medullaris congestive edema due to a cervical spine DAVF that was located at the C-5 level. Transarterial embolization with N-butyl cyanoacrylate closed the proximal vein and completely obliterated the fistula. Clinical and imaging follow-up confirmed occlusion of the fistula, with improvement in clinical symptoms.

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