scholarly journals Reconsidering an important subclass of high-risk dural arteriovenous fistulas for stereotactic radiosurgery

2019 ◽  
Vol 130 (3) ◽  
pp. 972-976 ◽  
Author(s):  
Daniel A. Tonetti ◽  
Bradley A. Gross ◽  
Brian T. Jankowitz ◽  
Hideyuki Kano ◽  
Edward A. Monaco ◽  
...  
Keyword(s):  
High Risk ◽  
Stereotactic Radiosurgery ◽  
Significant Risk ◽  
Venous Drainage ◽  
Significant Risk Factor ◽  
Low Risk ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Institutional Experience ◽  
Cortical Venous Drainage

OBJECTIVEAggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated.METHODSThe authors evaluated their institutional experience with SRS for dAVFs with CVD for the period from 1991 to 2016, assessing angiographic outcomes and posttreatment hemorrhage rates. They subsequently pooled their results with those published in the literature and stratified the results based on the mode of clinical presentation.RESULTSIn an institutional cohort of 42 dAVFs with CVD treated using SRS, there were no complications or hemorrhages after treatment in 19 patients with nonaggressive dAVFs, but there was 1 radiation-induced complication and 1 hemorrhage among the 23 patients with aggressive dAVFs. In pooling these cases with 155 additional cases from the literature, the authors found that the hemorrhage rate after SRS was significantly lower among the patients with nonaggressive dAVFs (0% vs 6.8%, p = 0.003). Similarly, the number of radiation-related complications was 0/124 in nonaggressive dAVF cases versus 6/73 in aggressive dAVF cases (p = 0.001). The annual rate of hemorrhage after SRS for aggressive fistulas was 3.0% over 164.5 patient-years, whereas none of the nonaggressive fistulas bled after radiosurgery over 279.4 patient-years of follow-up despite the presence of CVD.CONCLUSIONSCortical venous drainage is thought to be a significant risk factor in all dAVFs. In the institutional experience described here, SRS proved to be a low-risk strategy associated with a very low risk of subsequent hemorrhage or radiation-related complications in nonaggressive dAVFs with CVD.

scholarly journals Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data

2009 ◽  
Vol 26 (5) ◽  
pp. E14 ◽  
Author(s):  
Gregory J. Zipfel ◽  
Manish N. Shah ◽  
Daniel Refai ◽  
Ralph G. Dacey ◽  
Colin P. Derdeyn
Keyword(s):  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Risk Groups ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

This article presents a modification to the existing classification scales of intracranial dural arteriovenous fistulas based on newly published research regarding the relationship of clinical symptoms and outcome. The 2 commonly used scales, the Borden-Shucart and Cognard scales, rely entirely on angiographic features for categorization. The most critical anatomical feature is the identification of cortical venous drainage (CVD; Borden-Shucart Types II and III and Cognard Types IIb, IIa + b, III, IV, and V), as this feature identifies lesions at high risk for future hemorrhage or ischemic neurological injury. Yet recent data has emerged indicating that within these high-risk groups, most of the risk for future injury is in the subgroup presenting with intracerebral hemorrhage or nonhemorrhagic neurological deficits. The authors have defined this subgroup as symptomatic CVD. Patients who present incidentally or with symptoms of pulsatile tinnitus or ophthalmological phenomena have a less aggressive clinical course. The authors have defined this subgroup as asymptomatic CVD. Based on recent data the annual rate of intracerebral hemorrhage is 7.4–7.6% for patients with symptomatic CVD compared with 1.4–1.5% for those with asymptomatic CVD. The addition of asymptomatic CVD or symptomatic CVD as modifiers to the Borden-Shucart and Cognard systems improves their accuracy for risk stratification of patients with high-grade dural arteriovenous fistulas.

scholarly journals Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

2015 ◽  
Vol 122 (2) ◽  
pp. 353-362 ◽  
Author(s):  
Ching-Jen Chen ◽  
Cheng-Chia Lee ◽  
Dale Ding ◽  
Robert M. Starke ◽  
Srinivas Chivukula ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Venous Drainage ◽  
Classification Systems ◽  
Complication Rates ◽  
Obliteration Rate ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Cortical Venous Drainage

OBJECT The goal of this study was to evaluate the obliteration rate of intracranial dural arteriovenous fistulas (DAVFs) in patients treated with stereotactic radiosurgery (SRS), and to compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD). METHODS A systematic literature review was performed using PubMed. The CS DAVFs and the NCS DAVFs were categorized using the Barrow and Borden classification systems, respectively. The DAVFs were also categorized by location and by the presence of CVD. Statistical analyses of pooled data were conducted to assess complete obliteration rates in CS and NCS DAVFs, and in DAVFs with and without CVD. RESULTS Nineteen studies were included, comprising 729 patients harboring 743 DAVFs treated with SRS. The mean obliteration rate was 63% (95% CI 52.4%–73.6%). Complete obliteration for CS and NCS DAVFs was achieved in 73% and 58% of patients, respectively. No significant difference in obliteration rates between CS and NCS DAVFs was found (OR 1.72, 95% CI 0.66–4.46; p = 0.27). Complete obliteration in DAVFs with and without CVD was observed in 56% and 75% of patients, respectively. A significantly higher obliteration rate was observed in DAVFs without CVD compared with DAVFs with CVD (OR 2.37, 95% CI 1.07–5.28; p = 0.03). CONCLUSIONS Treatment with SRS offers favorable rates of DAVF obliteration with low complication rates. Patients harboring DAVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using SRS.

Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

2012 ◽  
Vol 32 (5) ◽  
pp. E18 ◽  
Author(s):  
Bradley A. Gross ◽  
Alexander E. Ropper ◽  
A. John Popp ◽  
Rose Du
Keyword(s):  
Stereotactic Radiosurgery ◽  
Venous Drainage ◽  
Review Of The Literature ◽  
Obliteration Rate ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Relative Paucity ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

Object Given the feasibility of curative surgical and endovascular therapy for cerebral dural arteriovenous fistulas (DAVFs), there is a relative paucity of radiosurgical series for these lesions as compared with their arteriovenous malformation counterparts. Methods The authors reviewed records of 56 patients with 70 cerebral DAVFs treated at their institution over the past 6 years. Ten DAVFs (14%) in 9 patients were treated with stereotactic radiosurgery (SRS), with follow-up obtained for 8 patients with 9 DAVFs. They combined their results with those obtained from a comprehensive review of the literature, focusing on obliteration rates, post-SRS hemorrhage rates, and other complications. Results In the authors' group of 9 DAVFs, angiographic obliteration was seen in 8 cases (89%), and no post-SRS hemorrhage or complications were observed after a mean follow-up of 2.9 years. Combining the results in these cases with data obtained from their review of the literature, they found 558 DAVFs treated with SRS across 14 series. The overall obliteration rate was 71%; transient worsening occurred in 9.1% of patients, permanent worsening in 2.4% (including 1 death, 0.2% of cases), and post-SRS hemorrhage occurred in 1.6% of cases (4.8% of those with cortical venous drainage [CVD]). The obliteration rate for cavernous DAVFs was 84%, whereas the rates for transversesigmoid and for tentorial DAVFs were 58% and 59%, respectively (adjusted p values, pcav,TS = 1.98 × 10−4, pcav,tent = 0.032). Obliteration rates were greater for DAVFs without CVD (80%, compared with 60% for those with CVD, p = 7.59 × 10−4). Both transient worsening and permanent worsening were less common in patients without CVD than in those with CVD (3.4% vs 7.3% for transient worsening and 0.9% vs 2.4% for permanent worsening). Conclusions Stereotactic radiosurgery with or without adjunctive embolization is an effective therapy for DAVFs that are not amenable to surgical or endovascular monotherapy. It is best suited for lesions without CVD and for cavernous DAVFs.

scholarly journals Arterial spin labeling MR imaging aids to identify cortical venous drainage of dural arteriovenous fistulas

Medicine ◽  
2018 ◽  
Vol 97 (19) ◽  
pp. e0697 ◽  
Author(s):  
Ji Hee Kang ◽  
Tae Jin Yun ◽  
Jong Kook Rhim ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Venous Drainage ◽  
Spin Labeling ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

scholarly journals Spontaneous Closure of Cerebral Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage

2009 ◽  
Vol 15 (3) ◽  
pp. 359-362 ◽  
Author(s):  
M. Voormolen ◽  
K. Geens ◽  
L. Van Den Hauwe ◽  
P.M. Parizel
Keyword(s):  
Contrast Medium ◽  
Venous Drainage ◽  
Spontaneous Closure ◽  
Fistula Closure ◽  
Selective Angiography ◽  
Cortical Vein ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

We describe two rare cases of spontaneous closure of cerebral dural arteriovenous fistulas (DAVFs) with a small nidus and draining directly in a single cortical vein with several ectasias. Eighteen previously published cases of spontaneous closure of cerebral DAVF comprised more benign fistula types. In literature, several explanations for DAVF occlusion have been proposed. We hypothesize that, in addition to the known causes, the specific contrast medium used during the diagnostic selective angiography might have played a role in the thrombosis and subsequent fistula closure.

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