Spontaneous resolution of a tentorial dural arteriovenous fistula fed by the artery of Wollschlaeger and Wollschlaeger after embolization of the main shunting point

Background: Tentorial dural arteriovenous fistula (TDAVF) is a rare intracranial vascular shunt. A TDAVF can be supplied by the Artery of Wollschlaeger and Wollschlaeger (AWW). However, a limited number of cases of TDAVF fed by the AWW have been reported to date. Case Description: A 70-year-old woman complaining of the right motor weakness underwent magnetic resonance imaging. A vascular lesion beneath the cerebellar tentorium was incidentally found with chronic infarction of the left corona radiata. Angiographically, the vascular lesion was a TDAVF supplied by the bilateral posterior meningeal arteries. No other apparent feeders were detected. The TDAVF had a shunting point on the inferior surface of the cerebellar tentorium with venous retrograde flow (Borden type III, Cognard type III). To prevent vascular events, endovascular embolization was performed using n-butyl-2-cyanoacrylate. Following embolization of the shunting point, a residual shunt fed by the AWW was identified. The shunt supplied by the AWW was not observed preoperatively. Follow-up angiography performed 1 week later revealed spontaneous disappearance of the residual shunt. The patient was followed-up in our outpatient clinic, and no recurrence of the TDAVF was confirmed postoperatively. Conclusion: Detection of mild feeding from the AWW to a TDAVF can be elusive preoperatively. Following embolization of the main shunting point, residual shunting from the AWW can resolve spontaneously.

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Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

The Neuroradiology Journal ◽

10.1177/19714009211041529 ◽

2021 ◽

pp. 197140092110415

Author(s):

Takuya Osuki ◽

Hiroyuki Ikeda ◽

Tomoko Hayashi ◽

Silsu Park ◽

Minami Uezato ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Balloon Angioplasty ◽

Dural Arteriovenous Fistula ◽

Executive Dysfunction ◽

Venous Drainage ◽

Transverse Sinus ◽

Sigmoid Sinus ◽

Shunt Flow ◽

Symptomatic Epilepsy ◽

The Right

Background There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. Case presentation A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus–sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus–sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. Conclusion Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.

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Dural Arteriovenous Fistula at the Anterior Condylar Confluence

Interventional Neuroradiology ◽

10.1177/159101990801400311 ◽

2008 ◽

Vol 14 (3) ◽

pp. 303-312 ◽

Cited By ~ 33

Author(s):

S. Miyachi ◽

T. Ohshima ◽

T. Izumi ◽

T. Kojima ◽

J Yoshida

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Three Dimensional ◽

Drainage Pattern ◽

Hypoglossal Canal ◽

Shunt Occlusion ◽

Meningeal Arteries ◽

Anterior Condylar Vein ◽

Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

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Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1736634 ◽

2021 ◽

Author(s):

Jenny Christine Kienzler ◽

Salome Schoepf ◽

Serge Marbacher ◽

Michael Diepers ◽

Luca Remonda ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Prone Position ◽

Popliteal Artery ◽

Dural Arteriovenous Fistula ◽

Endovascular Embolization ◽

Treatment Modalities ◽

Safe Procedure ◽

Spinal Dural Arteriovenous Fistula ◽

Segmental Artery ◽

Small Branch

Abstract Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

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Endovascular embolization of dural arteriovenous fistula in a child presented with slight conjunctival hyperemia

Child s Nervous System ◽

10.1007/s00381-019-04397-5 ◽

2019 ◽

Vol 35 (12) ◽

pp. 2435-2437 ◽

Cited By ~ 1

Author(s):

Lei Guo ◽

Ting Liu ◽

Xianli Lv

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Endovascular Embolization ◽

Conjunctival Hyperemia

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Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula

Journal of Neurosurgery ◽

10.3171/jns.1997.87.1.0109 ◽

1997 ◽

Vol 87 (1) ◽

pp. 109-112 ◽

Cited By ~ 21

Author(s):

Adnan A. Rahman Zurin ◽

Satoshi Ushikoshi ◽

Kiyohiro Houkin ◽

Yoichi Kikuchi ◽

Hiroshi Abe ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Transverse Sinus ◽

Cerebral Abscess ◽

Unusual Complication ◽

Content Type ◽

Cortical Infarction ◽

Retrograde Filling ◽

Detachable Coils ◽

The Right

This 63-year-old man presented with a right temporoparietal cortical infarction. A dural arteriovenous fistula involving the right transverse sinus was diagnosed on cerebral angiography. Transvenous embolization using detachable coils was performed; however, postembolization angiograms demonstrated retrograde filling of a cortical draining vein that was not seen on initial angiography. The patient subsequently developed a cerebral abscess in the region of the previous cortical infarction 2 months after the embolization. The abscess was successfully treated with drainage and antibiotic therapy. The authors report this case to illustrate an unusual complication associated with this procedure and the possible contribution of the cortical draining vein in the pathogenesis of the cerebral abscess.

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Monorail Snare Technique for the Retrieval of an Adherent Microcatheter from an Onyx Cast: Technical Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000310697.90077.f8 ◽

2008 ◽

Vol 63 (suppl_1) ◽

pp. ONSE89-ONS93 ◽

Cited By ~ 6

Author(s):

Michael E. Kelly ◽

Raymond Turner ◽

Vivek Gonugunta ◽

Peter A. Rasmussen ◽

Henry H. Woo ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Surgical Removal ◽

Occipital Artery ◽

Rapid Transit ◽

Arteriovenous Fistulas ◽

Bear Lake ◽

Vessel Tortuosity ◽

The Right ◽

Guiding Catheter

Abstract Objective: Microcatheters retained after Onyx (eV3 Neurovascular, Inc., Irvine, CA) embolization represent a potential source of thromboembolic complications. Catheter retention depends on the degree of Onyx reflux and vessel tortuosity. To overcome this problem, we have adapted a previously described monorail snare technique for stretched coils to remove an adherent microcatheter from the occipital artery during Onyx embolization of a dural arteriovenous fistula. Clinical Presentation: We used this technique successfully in a 62-year-old man with a posterior fossa dural arteriovenous fistula. An Echelon-10 microcatheter (eV3 Neurovascular, Inc.) system became adherent in the right occipital artery because of reflux and vessel tortuosity. Significant stretching of the microcatheter was observed during attempted removal. Intervention: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Rapid Transit microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling Echelon microcatheter was cut off and the snare advanced over the outside of the microcatheter. The snare and Rapid Transit microcatheter were then advanced into the guiding catheter (6-French) as a unit over the indwelling Echelon microcatheter. Using the adherent Echelon as a “monorail” guide, the snare and Rapid Transit microcatheter were advanced distally into the occipital artery and the snare was retracted to engage the microcatheter. The microcatheters and snare were then easily removed because of the second vector of force placed by the snare system on the adherent microcatheter very close to the point of adherence. Conclusion: The monorail snare technique represents a simple and safe way to remove an adherent microcatheter from an Onyx cast during the embolization of dural arteriovenous fistulas. Prospective knowledge of this technique will facilitate more aggressive embolization without the reservation that a retained microcatheter could require surgical removal or anticoagulation.

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WITHDRAWN: The role of intraoperative fluorescein angiography for anterior fossa dural arteriovenous fistula in the detection of residual shunt

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2014.02.005 ◽

2014 ◽

Author(s):

Yasuo Murai ◽

Masatoshi Kitazono ◽

Guangzhi Zhan ◽

Akio Morita ◽

Akira Teramoto

Keyword(s):

Fluorescein Angiography ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Residual Shunt ◽

Anterior Fossa

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Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy—a case report and review of the literature

Interventional Neuroradiology ◽

10.1177/1591019916654431 ◽

2016 ◽

Vol 22 (5) ◽

pp. 579-583 ◽

Cited By ~ 5

Author(s):

Hengwei Jin ◽

Xianli Lv ◽

Youxiang Li

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Brain Mri ◽

Venous Drainage ◽

Jugular Foramen ◽

Endovascular Embolization ◽

High Signal ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Progressive Weakness

We report a rare case of jugular foramen dural arteriovenous fistula (DAVF) with spinal venous drainage. A 48-year-old woman suffered from progressive weakness of lower extremities and incontinence of urine and feces for 14 days. Magnetic resonance imaging (MRI) revealed a tortuous posterior medullary vein at C2–T2 and ischemic signal at C2–C4 of the spinal cord. Brain MRI revealed an abnormal high signal near the left jugular foramen. Digital subtraction angiography of the spinal vascular was negative, while brain angiography showed a left jugular foramen DAVF with spinal perimedullary venous drainage. The patient recovered completely soon after endovascular embolization with Onyx-18. Diagnosis of a DAVF presenting with myelopathy is challenging. Early diagnosis and treatment are essential for a favorable outcome.

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