scholarly journals Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

2021 ◽  
Author(s):  
Xianli Lv ◽  
Ke Zhu ◽  
Jiangdian Wang
Keyword(s):  
Treatment Modalities ◽  
Grading System ◽  
Type Ii ◽  
Type Iii ◽  
Arteriovenous Fistulas ◽  
Grading Systems ◽  
Dural Arteriovenous Fistulas ◽  
Pre Treatment ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Effective Assessment

Abstract Objective:Dural arteriovenous fistulas (DAVFs) is a complex condition in neurovascular surgery. Many DAVF classifications have been reported and have changed over time in the literatures. The purposes of this study was to propose a practical and easy-to-follow grading system for DAVFs.Methods: From a retrospective analysis of our database, 143 DAVF patients were consecutively collected. Patients were grouped into modified Borden types I, II and III. Patients’ characteristics, treatment and outcomes were analyzed between 3 types. Patients’ pre-treatment status(pre-mRS) were analyzed between Borden, Cognard and modified Borden grading systems. Results:Male and non-sinus locations were statistically significantly correlated with the type III DAVF type (p<0.001). More than 3 pedical suppliers and pial arterial suppliers were associated with high grade (type II and III) DAVFs(p=0.003). Worse symptoms were present in most type II and type III patients(p<0.001). Type III DAVF was associated with TAE and type II DAVF was associated with TVE treatment modalities(p<0.001). The results of one-way ANOVA indicated that pre-mRS was significantly different within modified Borden types and Cognard types (p = 4.3×10-6 and p = 1×10-4, respectively). In terms of pre-mRS, patients were not separated well using Cognard grading systems.Conclusions: A modified grading system of cerebral and spinal DAVFs was promoted according to understanding of angioarchitectures in order to evaluate risk of DAVFs and guide the therapies of these lesions. The modified Borden grading system was informative by providing an effective assessment for the risk of patients with simple but precise results.

scholarly journals Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

2021 ◽  
Keyword(s):  
Full Text ◽  
Grading System ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

scholarly journals Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience

2021 ◽  
Author(s):  
Wilhelm Sorteberg ◽  
Angelika Sorteberg ◽  
Eva Astrid Jacobsen ◽  
Pål Rønning ◽  
Terje Nome ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Specific Treatment ◽  
Type I ◽  
Type Ii ◽  
Residual Symptoms ◽  
Type Iii ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Primary Treatment Modality ◽  
Dural Arteriovenous Fistulas

Abstract Background Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. We hypothesize that there may be subtypes of dAVFs responding better to a specific treatment modality in terms of successful obliteration and cessation of symptoms and/or risks. Methods All dAVFs treated during 2011–2018 at our hospital were analyzed retrospectively. Presenting symptoms, radiological variables, treatment modality, complications, and residual symptoms were related to dAVF type using the original Djindjian classification. Results We treated 112 dAVFs in 107 patients (71, 66% males). They presented with hemorrhage (n = 23; 21%), non-hemorrhagic symptoms (n = 75; 70%), or were discovered incidentally (n = 9; 8%). There were 25 (22%) type I, 29 (26%) type II, 26 (23%) type III, and 32 (29%) type IV fistulas. EVT was the primary treatment modality in 72/112 (64%) dAVFs whereas 40/112 (36%) underwent primary surgery with angiographic obliteration rates of 60% and 90%, respectively. Using a secondary treatment modality in 23 dAVFs, we obtained a final obliteration rate of 93%, including all type III/IV and 26/27 (96%) type II dAVFs. Except for headache, residual symptoms were rare and minor. Permanent neurological complications consisted of five cranial nerve deficits. Conclusions We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk.

Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 137-144 ◽  
Author(s):  
Nicolaas A. Bakker ◽  
Maarten Uyttenboogaart ◽  
G.J. Luijckx ◽  
Omid S. Eshghi ◽  
Aryan Mazuri ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Endovascular Techniques ◽  
Recurrence Rates ◽  
Arteriovenous Fistulas ◽  
Initial Failure ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND: There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery. OBJECTIVE: To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques. METHODS: A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration. RESULTS: A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8–97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1–75.9; P &lt; .001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45–11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66–5.96; P &lt; .001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75–8.37; P = .13). CONCLUSION: Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.

Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein

2006 ◽  
Vol 105 (4) ◽  
pp. 636-639 ◽  
Author(s):  
Dennis J. Rivet ◽  
James K. Goddard ◽  
Keith M. Rich ◽  
Colin P. Derdeyn
Keyword(s):  
Endovascular Treatment ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Type Ii ◽  
Emissary Vein ◽  
Arteriovenous Fistulas ◽  
Mastoid Emissary Vein ◽  
Vein Access ◽  
Dural Arteriovenous Fistulas ◽  
Gain Access

✓ Definitive endovascular treatment of dural arteriovenous fistulas (DAVFs) requires obliteration of the site of the fistula: either the diseased dural sinus or the pial vein. Access to this site is often limited by occlusion of the sinus proximal and distal to the segment containing the fistula. The authors describe a technique in which the mastoid emissary vein is used to gain access to a Borden–Shucart Type II DAVF in the transverse–sigmoid sinus. Recognition of this route of access, if present, may facilitate endovascular treatment of these lesions. Access to the transverse sinus via this approach can be straightforward and may be underused.

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

2012 ◽  
Vol 32 (5) ◽  
pp. E17 ◽  
Author(s):  
Jennifer E. Fugate ◽  
Giuseppe Lanzino ◽  
Alejandro A. Rabinstein
Keyword(s):  
Spinal Cord ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Intramedullary Spinal Cord ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Signal Abnormality ◽  
Dural Arteriovenous Fistulas ◽  
Sensory Disturbances ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

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